摘要
目的探索乳腺癌前哨淋巴结(SLN)状态与临床病理特征的关系以及建立乳腺癌SLN转移的预测模型,以提高SLN的检出率并降低其假阴性率。方法选取2015年1月至2016年1月于山东大学齐鲁医院接受手术治疗的146例女性乳腺癌患者为研究对象,比较单用亚甲蓝(89例)与亚甲蓝联合吲哚菁绿(ICG)(41例)两种SLN示踪方案的检出率,研究冰冻病理(FS)联合组织印片细胞学检查在术中SLN诊断中的应用价值,通过对SLN转移的危险因素进行分析、筛选,建立回归方程并计算每例患者的预测值,通过受试者工作特征曲线(ROC)选取截断点,构建SLN转移的预测模型。结果亚甲蓝标记组检出率为95.51%(85/89),假阴性率为11.76%(4/34);亚甲蓝联合荧光标记组检出率为100%(41/41),假阴性率为0%(0/10)。146例行前哨淋巴结活检术(SLNB)的患者术中全部进行FS,准确率为95.89%(140/146),假阴性率为12.00%(6/50);39例术中进行FS联合组织印片,准确率为100%(41/41),假阴性率为0%(0/11)。多因素分析结果显示,年龄(OR=0.855,95%CI 0.815~0.896)、肿瘤的组织学类型(OR=2.247,95%CI 1.039~4.858)、雌二醇(OR=0.805,95%CI 0.800~0.810)及原癌基因人类表皮生长因子受体(Her-2)(OR=0.457,95%CI 0.210~0.995)是SLN转移的影响因子。结论 SLNB的假阴性率较低,对于大多数早期乳腺癌患者,SLNB安全可行,但是对于年轻、雌二醇水平高、Her-2基因低表达及原发病灶组织学类型为浸润性的乳腺癌患者行SLNB发生假阴性的风险较高。
Objective To explore the correlation between sentinel lymph node （SLN） status and elinieopathologieal characteristics and establish the prediction model of SLN metastasis in breast cancer, so as to improve the identification rate and reduce the false negative rate. Methods A total of 146 women with breast cancer who received surgery in Qilu Hospi- tal of Shandong University from Jan. 2015 to Jan. 2016 were included in the study. The identification rate of SLNs marked by blue dye（methylene blue）（89 eases） and methylene blue combined with fluorochrome（indocyanine green, ICG） （41 eases） were compared and then the diagnostic value of frozen section（FS） combined with touch imprint cytology in SLN was studied. And we established the model of SLN metastasis via selecting the cutoff value of receiver operating characteris- tic curve（ROC） by analyzing and filtrating the risk factors of SLN metastasis, establishing regressive equation and calculat- ing the predictive value of all patients. Results The identification rate of methylene blue marked group was 95.51% （85/ 89 ） and the false negative rate was 11.76% （4/34）, however the identification rate of methylene blue combined with ICG marked group was 100% （41/41） and the false negative rate was 0% （0/10）. All 146 patients who received SLN biopsy （SLNB） had intraoperative FS：the accuracy was 95.89% （140/146）, and the false negative rate was 12%. 00（6/50） ;39 patients had intraoperative FS and touch imprint： the accuracy was 100% （41/41） , and the false negative rate was 0% （0/11）. The incidence of metastatic SLN was related with such risk factors as patient age（ OR =0. 855,95% C1 0. 8154）. 896）,tumor histological type（ OR = 2. 247,95% CI 1. 039-4. 858 ）, estradiol （ OR = 0. 805,95% C1 0. 8004）. 810） and human epidermal growth factor receptor-2 （ Her-2 ） （ OR = 0. 457,95% C1 0. 210-0. 995 ）, as indicated by multi-factor analysis. Conclusion In our study, we found that since the false
作者
王晓婷
杨其峰
菅向东
FANG Xiaoting;YANG Qifbng;JIAN Xiangdong(Department of Emergency,Poiso-ning and Occupational Diseases;Department of Breast Surgery,Qilu Hospital of Shandong University,Jinan 250012,China)
出处
《医学综述》
2018年第18期3693-3697,3704,共6页
Medical Recapitulate
关键词
乳腺癌
前哨淋巴结
检出率
假阴性率
Breast cancer
Sentinel lymph node
Identification rate
False negative rate
