【作者】 凌立君； 陈翔； 查小明； 丁强； 刘晓安； 徐兆强； 王水；

【Author】 CHEN Xiang,ZHA Xiaoming,WANG Shui,et al.Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China

【机构】 南京医科大学第一附属医院乳腺外科；

【摘要】 目的:研究通过前哨淋巴通道(sentinel lymph channel,SLC)行前哨淋巴结活检(sentinel lymphnode biopsy,SLNB),并根据SLNB的结果行选择性腋窝淋巴结清扫(axillary lymph node dissection,ALND)的可行性。方法:采用非随机对照研究,通过前哨淋巴通道行SLNB。根据术中SLN的病理诊断结果行选择性ALND的患者为A组,其中SLN为阳性,行ALND为A1组,SLN为阴性,仅行SLNB为A2组;无论SLN状态,SLNB后均行ALND的患者为B组。结果:2008年7月至2009年6月共114例早期乳腺癌患者行SLNB,检出SLN 112例,A1组28例,A2组25例,B组59例;其中联合法检出率为98.1%(102/104),染料法检出率为100%(10/10),两者差异无统计学意义(P>0.05)。假阴性率为2.3%(2/87)。SLNB检出淋巴结1～4枚,共146枚,平均1.3枚。冰冻切片阳性26例,灵敏度为92.0%(103/112),细胞印片阳性25例,灵敏度为91.1%(102/112),两者联合阳性29例,灵敏度为94.6%(106/112),三种检测方法差异无统计学意义(P>0.05)。在印片细胞学检查中发现1例正常上皮细胞。ALND组(A1+B)并发症发生率(52.9%)高于SLNB组(A2)并发症发生率(4%)(X~2=15.9675,P<0.001)。结论:通过SLC行SLNB准确可靠,有助于识别SLN和非SLN,可指导选择性的ALND,减少术后并发症的发生,准确的快速病理诊断方法、SLNB的假阳性等问题需要进一步研究。更多还原

【Abstract】 Objective:To study the feasibility of selective axillary lymph node dissection (ALND) according to the results of sentinel lymph node biopsy(SLNB) following sentinel lymph channel(SLC).Methods:In this prospective non-randomized study,all patients received SLNB following SLC.Patients in Group A received selective ALND according to the intraoperative pathologic results of SLNs,Patients in Group A1 received ALND when the SLNs were positive, patients in Group A2 received SLNB only in case of negative SLNs;and all patients in Group B received ALND following SLNB whatever the status of SLNs were.Results:From Jul.2008 to Jun. 2009,114 patients with early breast cancer received SLNB and 112 patients’ SLNs were identified successfully.28,25 and 59 patients were selected as Group A1,A2 and B,respectively.The dissection rates of SLNB with combinative method and blue dye method were 98.1%(102/104) and 100%(10/10)(P>0.05),respectively,and the false negative rate was 2.3%(2/87).The number of SLN harvested by SLNB was 1～4 with a tot of 146 and an average of 1.3 per patient.Positive SLNs were found by intraoperative frozen section,touch cytology and combinative method in 26, 25 and 29 patients,respectively,with the sensitivities of each methods were 92.0%(103/112), 91.1%(102/112) and 94.6%(106/112),there isn’ t a significant difference among the three methods (P>0.03).Interestingly,we found a few normal epithelial cells by intraoperative touch cytology in a patient.The compliacation rate for ALND(52.9%) was higher than that for SLNB(4%)(X ~2=15.9675,P<0.001).Conclusions:SLNB following SLC was accurate and reliable,which could help to identify SLN or non-SLN and direct the selective ALND and decrease the complication.And the questions about the proper intraoperative pathological diagnostic method and what is the mean of the false positive rate of SLNB need futher studies.更多还原