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目的评价核素淋巴显像和γ探针定位在乳腺癌中确定前哨淋巴结(SLN)的应用价值,验证前哨淋巴结活检替代腋窝淋巴结清除术用于乳腺癌治疗的安全性与价值。方法选择1999年6月至2009年11月本院住院的女性乳腺癌患者206例(体检时腋窝均未扪及肿块),应用99Tcm-DX37～74 MBq或99Tcm-SC74 MBq经皮下注射,行核素淋巴显像后,术中注射专利兰1 ml和(或)术中用γ探针定位并行前哨淋巴结活检,与术中冰冻病理检查结果对照。若术中冰冻发现有前哨淋巴结转移,则行腋窝淋巴结清除术,若前哨淋巴结阴性,则不做腋窝淋巴结清除,术后定期随访。结果 206例乳腺癌术中成功活检SLN204例,成功率为99.0%(204/206)。本组有64例仅行SLN切除,术后病理检查证实64例SLN均阴性,故未行腋窝淋巴结清除,其中仅1例于术后1年时出现腋窝淋巴结转移,其余63例患者在随访期间均未发现腋窝淋巴结转移,也未出现同侧上肢水肿、感觉及活动异常;另140例行腋窝淋巴结清除,其中6例经病理证实SLN阳性但腋窝淋巴结为阴性,134例经病理证实SLN阳性35例,阴性99例,腋窝淋巴结阳性37例,阴性97例。核素淋巴显像和γ探针定位法的灵敏度为94.6%(35/37例),准确率为98.5%(138/140),假阴性为5.4%(2/37)。结论核素淋巴显像和γ探针定位应用于乳腺癌是切实可行和可能的,对预测腋窝淋巴结转移有很大的临床实用价值。如技术方法规范,早期乳腺癌前哨淋巴结活检则能取代常规的腋窝淋巴结清除术,乳腺癌手术上肢并发症的发生率可大大降低。
Objective To evaluate the value of lymphatic imaging and γ-probe localization in the determination of sentinel lymph node (SLN) in breast cancer and to verify the safety and value of sentinel lymph node biopsy instead of axillary lymph node dissection in the treatment of breast cancer. Methods A total of 206 female breast cancer patients admitted to our hospital from June 1999 to November 2009 were selected. Subcutaneous injection of 99Tcm-DX 37-74 MBq or 99Tcm-SC74 MBq subcutaneously After lymphatic imaging, intraoperative injection of patent 1 ml and / or intraoperative use of γ-probe localization parallel sentinel lymph node biopsy, and intraoperative frozen pathological examination results. If the intraoperative frozen sentinel lymph node metastasis, the axillary lymph node dissection, if the sentinel lymph node-negative, then do axillary lymph node dissection, regular follow-up. Results 206 cases of breast cancer were successfully biopsied SLN 204 cases, the success rate was 99.0% (204/206). 64 cases of this group only SLN resection, postoperative pathology confirmed that 64 cases of SLN were negative, it did not line axillary lymph node clearance, of which only 1 case of axillary lymph node metastases at 1 year after surgery, the remaining 63 patients during follow-up No axillary lymph node metastases, nor ipsilateral upper extremity edema, sensory and abnormal activity were found. Another 140 axillary lymph nodes were cleared, of which 6 were pathologically confirmed SLN positive but axillary lymph nodes were negative, 134 were pathologically confirmed SLN positive 35 Cases, negative 99 cases, axillary lymph node positive in 37 cases, negative 97 cases. The sensitivity of nuclide lymphatic imaging and γ-probe localization was 94.6% (35/37 cases), the accuracy was 98.5% (138/140) and the false negative was 5.4% (2/37). Conclusion The application of lymphadenectomy and γ-probe localization in breast cancer is feasible and possible, and it has great clinical value in predicting axillary lymph node metastasis. As the technical methods, early breast cancer sentinel lymph node biopsy can replace conventional axillary lymph node dissection, breast cancer surgery, the incidence of upper limb complications can be greatly reduced.