摘要
目的探讨影响染料法乳腺癌前哨淋巴结活检(sentinellymphnodebiopsy,SLNB)成功率的因素及其可能机制。方法172例T1、T2乳腺癌病人,其中术前腋窝触及肿大淋巴结者16例。全身麻醉后,采用1%异硫蓝5ml或美蓝4ml,随机注入乳晕或肿瘤周围后行SLNB;然后作根治术或改良根治术,并将全部标本送病理学检查。比较病人年龄、腋窝淋巴结肿大、术前活检、肿瘤大小、组织类型、染料、注射部位、训练曲线等因素对SLNB检出率的影响。结果在术前触及腋窝淋巴结肿大的16例中,前哨淋巴结(sentinellymphnode,SLN)的检出率明显低于未触及者(χ2=18.355,P=0.000),而假阴性率则明显增高(χ2=12.205,P=0.000)。位于外上象限的肿瘤SLNB前行切除活检,SLN的检出率显著降低(χ2=5.690,P=0.017)。前30例SLN的检出率明显低于后142例(χ2=5.807,P=0.016)病人的年龄、肿瘤位置、肿瘤大小、组织类型、染料以及注射部位等因素对SLNB成功率影响不大(P>0.05)。结论术前腋窝淋巴结肿大及SLNB前行外上象限肿瘤切除活检可明显影响SLNB的成功率,其原因可能与乳腺至腋窝之间的淋巴引流途径改变有关。通过训练可提高SLN的检出率。
Objective To study factors that might affect the success rate of sentinel lymph node biopsy (SLNB) by using living dyes in breast cancer patients. Methods After induction of general anesthesia, 5 ml of 1% isosulfan blue or 4 ml of methylene blue was injected around the tumor or into the subareola breast parenchyma at random, and approximately 5 minutes later. SLNB was performed. A total of 172 patients(in which axillary lymph nodes were palpable in 16 cases), undergoing modified radical mastectomy or radical mastectomy with complete axillary lymph nodes dissection (ALND) were studied. All nodes in the ALND specimen were processed for histological examination using hematoxylin and eosin staining. Factors such as age, clinically palpable axillary node(s), process of excision biopsy, tumor size, pathologic classification, type of living dyes, location of injection and training curve were compared to explore the success rate of SLNB. Results The rate of detection of sentinel lymph node (SLN) in 16 cases with palpable axillary node(s) was lower (χ2=18.355, P=0.000) while the pseudo-negative rate was higher (χ2=12.205, P=0.000) than that in 156 cases with no palpable axillary nodes. The rate of detection of SLN in patients with tumor located in the upper-outer quadrant was lower than that in the other quadrants (χ2=5.690, P=0.017).The rate of detection of SLN in the first 30 case was lower than that in latter 142 patients(χ2=5.807,P=0.016). The other factors such as age, tumor size, pathologic classification, type of living dyes and location of injection position did not influence statistically the success rate of SLNB (P>0.05). Conclusion Enlarged axillary node(s) and the process of excision biopsy of tumor located in the upper-outer quadrant might change the pathway(s) of lymphatic drainage between the subareolar region and the axilla, and could therefore reduce the success rate of SLNB. The rate of SLN detection could be improved by repeated practive.
出处
《外科理论与实践》
2004年第2期107-109,共3页
Journal of Surgery Concepts & Practice
基金
国家十五攻关课题(2001BA703B20)
江苏省卫生系统重点人才基金(135工程)
