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目的 初步探讨乳腺癌前哨淋巴结 (sentinellymphnode ,SLN )检测的可行性 ,SLN预测腋窝淋巴结状态的可靠性。 方法 对我院普外科收治的 15例T1～ 2 期、腋窝未扪及肿大淋巴结的乳腺癌病人 ,使用99mTc右旋糖酐或99mTc硫胶体为示踪剂 ,γ探测仪探测SLN ,然后进行活检和腋窝淋巴结清扫 (axillarylymphnodedissection ,ALND) ,两处标本同时送病理检查 ,以此来评价SLN的病理组织学结果能否准确地反映腋窝淋巴结状态。 结果 在 10例病人中发现SLN ,发现率为 6 6 .6 % ( 10 /15 )。SLN的数量为 1～ 3枚 /例 ,平均 2 .1枚 /例。非前哨淋巴结 (non sentinellymphnode ,NSLN) 5～ 16枚 /例 ,平均 10 .3枚 /例。发现SLN的 10例病人中 1例 ( 10 % )SLN有癌转移 ,其他腋窝淋巴结未见转移 ;2例SLN未发现癌转移而NSLN有癌转移 ,假阴性率 2 0 % ( 2 /10 ) ,准确性 80 % ( 8/10 )。 结论 乳腺癌前哨淋巴结定位和活检技术以及预测腋窝淋巴结状态的可靠性方面有待进一步积累经验 ,提高准确性 ,降低假阴性率。
Objective To explore the feasibility of sentinel lymph node (SLN) detection in breast cancer. SLN predicts the reliability of axillary lymph node status. Methods Twenty-nine patients with T1～2 stage breast cancer without lymph node and axillary lymph node treated by general surgery in our hospital were treated with 99mTc dextran or 99mTc sulfur colloids as tracers. The gamma detector detected SLN, then biopsy and armpits were performed. The axillary lymph node dissection (ALND) was performed at the same time in both specimens to assess whether the histopathological results of SLN accurately reflected the axillary lymph node status. Results SLN was found in 10 patients and the discovery rate was 66.6% (10/15). The number of SLNs is 1 to 3 pieces/case, with an average of 2.1 pieces/case. Non-sentinel lymph nodes (NSLN) range from 5 to 16 per patient, with an average of 10.3 per patient. Among 10 patients with SLN, 1 (10 %) had SLN metastasis and no metastasis to other axillary lymph nodes. 2 SLNs had no metastasis and NSLN had metastasis with a false negative rate of 20% (2/10). Accuracy 80% (8/10). Conclusions Sentinel lymph node localization and biopsy techniques for breast cancer and the reliability of predicting the status of axillary lymph nodes need to be further accumulated to improve accuracy and reduce the false negative rate.