【摘要】 目的:探讨应用放射性示踪剂进行乳腺癌前哨淋巴结(sentinel lymph node,SLN)活检时出现假阴性的原因,探索降低假阴性率的方法。方法:收集2000年5月—2007年5月进行乳腺癌SLN活检150例,术前注射99mTc标记的右旋糖酐(99mTc-DX),术中应用γ探测仪进行SLN探测,术后将SLN单独送检进行病理学检查。结果:SLN活检的成功率为96%,灵敏度为93.4%,特异度为100%,假阴性率为6.6%,假阳性率为0,准确度为97.2%,阳性结果预测值为100%,阴性结果预测值为95.4%,尤登指数(正确指数)为0.934。假阴性与适应证的选择、解剖变异、术前活检和放疗、内乳SLN的出现、多灶性病变、病理学检查不彻底、探测技术不熟练有关。结论:严格掌握SLN活检适应证,严格按标准的操作规程进行探测,术中仔细认真,术后对SLN进行详细的病理学检查,可以逐步将假阴性率降低到可接受的程度。更多还原

【Abstract】 Objective:To investigate the reasons for false negative test results of sentinel lymph node(SLN) biopsy using isotope for patients with breast cancer and discuss how to reduce the false negative rate.Methods:The SLNs were identified in 150 breast can-cer patients between May 2000 and May 2007.99mTc-labeled dextran(99mTc-DX) was injected pre-operatively,then the localization of SLN was identified by γ-detecting probe intraoperatively,finally the removed SLNs were confirmed by routine pathological examination.Results:The detection rate of SLN biopsy was 96%.The sensitivity,specificity,false negative rate,false positive rate,and accuracy of SLN detection were 93.4%,100%,6.6%,0%,and 97.2%,respectively.The positive and negative predictive value were 100% and 95.4%,respectively.Youden’s index was 0.934.The false negative rate was associated with the selection of indication,anatomic variation,preoperative biopsy and radiotherapy,appearance of internal mammary SLN,multifocality,incomplete pathological examination and inexperienced skills.Conclusion:The false negative rate could be reduced to an acceptable degree gradually by strictly selecting indications for SLN biopsy,probing SLN location according to standard operating procedure,keeping seriousness,performing post-operative pathological examination.更多还原