摘要
目的探讨亚甲蓝注射液染色示踪在前哨淋巴结活检(SLNB)中的可行性及其应用价值。方法选择2001年10月—2009年12月经联合检测方法诊断为乳腺癌的患者182例,采用1%亚甲蓝注射液4 ml分4点注射于肿瘤周围或已切除瘤腔壁周围乳腺组织内,局部按摩5～10 min后,先行SLNB再行腋窝淋巴结清扫(ALND),两标本均标记送常规切片或苏木素-伊红(HE)染色检查。参照美国Louisvill大学对SLNB技术的评价标准:检出率=检出前哨淋巴结(SLN)的例数/接受活检的例数×100%;准确率=(SLN真阳性例数+真阴性例数)/SLNB总例数×100%;灵敏度=SLN阳性例数/腋窝淋巴结(ALN)转移例数×100%;假阴性率=SLN假阴性例数/ALN转移例数×100%。结果本组182例患者中,发现SLN 172例(检出率为94.50%),未发现10例,SLN全部染色143例,大部分染色16例,小部分染色8例,极小部分染色5例。SLN转移69例,微转移1例,无转移102例,未发现跳跃性转移。而ALND转移80例,无转移92例,灵敏度为87.50%(70/80)。SLN与ALN经病理检查完全符合162例,准确率为94.18%(162/172);假阴性10例,假阴性率为12.50%(10/80);假阳性0例。活检出SLN平均为1.5枚(0～4枚),ALN平均为12枚(10～36枚)。结论 SLN是肿瘤淋巴转移必经的第一站淋巴结,SLNB预测淋巴转移准确率高,亚甲蓝染色法在SLNB中安全价廉、效果好、易推广,SLNB可以取代ALND,从而提高患者的生活质量。
Objective To study the feasibility and application of methyleneblue in sentinel lymph node biopsy. Meth- ods Totally 182 patients diagnosed with breast cancer by joint detection from October 2001 to December 2009 were selected. Then 4 ml methyleneblue injection was injected into the peritumoral tissues or breast tissues around the cavity wall of the excised tumor, and the local massage was performed for 5 to 10 minutes. Sentinel lymph node biopsy （SLNB） was firstly performed be- fore axillary lymph node biopsy （ALND） was performed. The two samples were both marked and were given conventional biopsy or HE chromoscopy. The evaluation criterion of Louisvill University on SLNB was adopted ： Detection rate = SLN detected cases ＋ cases performed biopsy x 100% ; Accuracy rate = （ SLN true positive cases ＋ SLN true negative cases） ＋ total SLNB cases ~ 100% ; Sensitivity = SLN positive cases ＋ ALN metastasis cases ~ 100% ; False negative rate = SLN false negative cases ＋ ALN metastasis cases x 100%. Results Among the 182 cases, 172 cases were detected with SLN （ detection rate was 94. 50% ）. SLN was all stained in 143 cases, mostly stained in 16 cases, fractionally stained in 8 cases and extremely fractionally stained in 5 cases. Among them 69 cases had SLN metastasis, one case had micrometastasis, 102 cases had no metastasis; no skip metas- tasis was detected. Furthermore, 80 cases had ALND metastasis, 92 cases had no metastasis, and the sensitivity was 87. 50% （70/80）. The SLN and ALN fully complied with pathological examination in 162 cases, and the accuracy rate was 94. 18% （162/172）. Ten cases were false negative, and the false negative rate was 12. 50% （10/80）. No case was false positive. The average SLN by biopsy was 1.5 pieces （0 -4 pieces） and the average ALN was 12 pieces （10 -36 pieces）. Conclusion SLN is the first lymph node that the lymphatic metastasis of tumor has to pass by. SLNB has high accuracy rate in predicting lymphatic metastasis, and the methyleneblue
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第26期3028-3030,共3页
Chinese General Practice
