【作者】 宋向阳； 谢树夺； 秦川； 潘滔； 陈文军； 袁晓明； 楼岑； 金梅； 王林波； 吴金民；

【Author】 Song Xiang-Yang Qin Chuan Xie Shu-Duo et al. Surgical Oncology, Sir Run Run Shaw Hospital, Medical College of Zhe-jiang University. Hangzhou 310016, China

【机构】 浙江大学医学院附属邵逸夫医院肿瘤外科；

【摘要】 目的:乳腺癌前哨淋巴结定位活检能以较小的创伤准确地预测区域淋巴结转移情况,从而避免一部分腋淋巴结阴性的乳癌病人进行不必要的淋巴结清扫。目前前哨淋巴结定位活检已越来越显示出替代传统的腋淋巴结清扫的趋势。然而用核素法行乳腺癌前哨淋巴结定位活检中,对于放射活性的前哨淋巴结定义尚无统一标准,各家根据不同情况有不同的标准,这会不会对前哨淋巴结定位活检的结果以及结论的阐述产生影响,是一个值得探讨的问题。本研究前瞻性地比较三种不同前哨淋巴结定义对乳腺癌前哨淋巴结定位活检所产生的影响。方法:自2002年1月到2005年4月, 共有89例临床分期为T1-2N0M0的患者同时按照不同的定义进行了核素法前哨淋巴结定位活检,前瞻性地比较三种不同前哨淋巴结定义在同一患者中的不同结果:定义一:有最高放射活性计数的淋巴结。定义二:任何淋巴结其体外放射活性和非前哨淋巴结的比值至少为10:1或其体内活性和背景值的比至少为3:1,并且最终活检床的放射活性不超过背景值的2倍,否则应继续寻找可能存在的前哨淋巴结。定义三:所有有放射活性的淋巴结。一般按照定义一、二、三的顺序进行定位活检,只要找到符合定义的淋巴结被认为相应标准的前哨淋巴结定位活检成功。结果:三种定义的前哨淋巴结定位活检成功率皆为96．6％,敏感性分别为90．7％, 96．5％,98．8％,假阴性率分别为21．1％,7．9％,2．6％,准确性分别为90．7％,96．5％,98．8％。按照前哨淋巴结的放射活性的高低顺序排列,在第1枚就定位活检到阳性前哨淋巴结的患者占所有前哨淋巴结阳性患者的81．1％(30／37), 在前2枚活检到有阳性前哨淋巴结的占89．2％(33／37),在前3枚活检到有阳性前哨淋巴结的占94．6％(35／38),而在前4枚活检到有阳性前哨淋巴结的占100％(37／37),在第5枚以后的前哨淋巴结未能进一步提高阳性检出比率,即未能进一步降低假阴性率。结论:用核素法进行乳腺癌前哨淋巴结定位活检时,不同的前哨淋巴结定义对其准确性和敏感性有很大影响,根据本研究,我们认为比较合适的定义是:按按放射活性从大到小的顺序,定位活检到的前四枚淋巴结为前哨淋巴结。更多还原

【Abstract】 Objective: To study the different impact of three different criteria of sentinel lymph node definition in sentinel node biopsy with isotope in breast cancer. Methods: Prospectively compared the different results using Tm99-sulfur colloid for sentinel node biopsy in the same patient with different definition. Definition 1: any lymph node with the highest radioactivity. Definition 2: any lymph nodes with in vivo radioactivity 3 or more times as high as the background, or ex vivo 10 or more times as high as non-sentinel nodes, the radioactivity of final biopsy bed should be 2 times less than the background, otherwise search for the possible sentinel nodes is mandatory. Definition 3: all the nodes with radioactivity. Results: With three different definitions, the success rate of sentinel node biopsy were all 96.6%, the sensitivity was 90.7% ,96. 5%, 98.8% respectively, false negative rate 21.1%, 7.9 %, 2.6% respectively, predicting accuracy 90.7%, 96. 5%, 98.8% respectively. In descending order of the radioactivity of sentinel nodes, in the patients with positive sentinel nodes, the ratio of the patients with positive sentinel nodes identified within the first, the first 2, the first 3 and the first 4 nodes was 81.1%, 89.2%, 94.6%, 100%. Conclusion: The different definition of sentinel lymph node had different impact to the accuracy, sensitivity and false negative rate during sentinel node biopsy with radioactive sulfur colloid in breast cancer patients. In descending order of the radioactivity of sentinel nodes, the first four nodes could accurately predict the status of axilla.更多还原