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[目的]比较腋窝前哨淋巴结(SLN)导航的淋巴结群切除与单纯前哨淋巴结活检(SLNB)的优劣,探讨其作为早期乳腺癌外科腋窝处理手段的可行性及临床意义。[方法]2003年10月至2009年5月,连续入组305例早期乳腺癌手术病例,术中序贯施行腋窝SLNB、SLN所在淋巴结群切除及全腋窝淋巴结清扫(ALND),比较SLNB与SLN导航的淋巴结群切除活检预测腋淋巴结状态的差异并分析影响淋巴结状态的因素。[结果]SLNB成功率为99.34%(303/305)。SLNB假阴性10例,SLNB预测淋巴结状态假阴性率为9.80%(10/102)、敏感性90.20%(92/102)、准确性96.70%(293/303)、阴性似然比0.098。SLN导航的淋巴结群切除活检预测腋淋巴结状态的假阴性率为1.96%(2/102)、敏感性98.04%(100/102)、准确性99.34%(301/303)、阴性似然比0.020。淋巴结状态与肿瘤大小、脉管浸润、组织学分级及Her-2状态相关(P<0.05)。[结论]以腋窝SLN导航的淋巴结群切除替代ALND治疗早期乳腺癌较单纯SLNB更具安全性及应用价值。结合肿瘤大小、脉管浸润、组织学分级及Her-2状态有助于更准确地指导腋窝淋巴结处理方式。
[Objective] To compare the advantages and disadvantages of lymph node resection and simple sentinel lymph node biopsy (SLNB) guided by axillary lymph node (SLN) and explore its feasibility and clinical significance as a surgical axillary approach for early breast cancer. [Methods] From October 2003 to May 2009, 305 consecutive cases of early breast cancer surgery were enrolled in this study. Armpit SLNB, lymph node group resection and axillary lymph node dissection (ALND) Navigational lymph node biopsy predicts differences in axillary lymph node status and analyzes factors that affect lymph node status. [Results] The success rate of SLNB was 99.34% (303/305). The false negative rate of SLNB was 9.80% (10/102), the sensitivity was 90.20% (92/102), the accuracy was 96.70% (293/303) and the negative likelihood ratio was 0.098. The SLN-guided lymph node biopsy predicted axillary lymph node status with a negative rate of 1.96% (2/102), sensitivity of 98.04% (100/102), accuracy of 99.34% (301/303), and negative likelihood ratio of 0.020. Lymph node status correlated with tumor size, vascular invasion, histological grade and Her-2 status (P <0.05). [Conclusion] The axillary SLN-guided lymph node resection in the treatment of early stage breast cancer is more safe and practical than the simple SLNB. Combined with tumor size, vascular invasion, histological grade and Her-2 status help to more accurately guide the treatment of axillary lymph nodes.