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目的探讨术前淋巴显像在乳腺癌前哨淋巴结活检术(SLNB)中的价值。方法前期回顾性分析山东省肿瘤医院2000年9月至2007年6月接受SLNB的716例乳腺癌病人的资料,所有病人均行术前淋巴显像;后期的前瞻性研究共入组山东省肿瘤医院2007年7月至2009年11月接受SLNB的565例乳腺癌病人,随机分为术前淋巴显像组和不行淋巴显像组。结果回顾性研究术前淋巴显像成功率为86.6%,只与术后腋淋巴结病理状况显著相关(P=0.003);术前腋窝淋巴显像成功与失败组间核素法SLNB成功率的差异有统计学意义(P<0.001),但核素法SLNB假阴性率、联合法SLNB成功率及假阴性率的差异均无统计学意义(分别P=0.731,P=0.174,P=0.947)。前瞻性研究术前淋巴显像组(82.1%显像成功)和不行淋巴显像组核素法SLNB成功率及假阴性率、联合法SLNB成功率及假阴性率的差异均无统计学意义(分别P=0.757,P=1.00,P=1.00,P=1.00)。结论术前淋巴显像既不能提高SLNB的成功率,也不能降低其假阴性率,临床实践中乳腺癌SLNB术前可以不行淋巴显像;术中联合使用蓝染料和γ探测仪同样可以准确进行SLNB。
Objective To investigate the value of preoperative lymphoscintigraphy in sentinel lymph node biopsy (SLNB) in breast cancer. Methods The data of 716 breast cancer patients who underwent SLNB from September 2000 to June 2007 in Shandong Tumor Hospital were retrospectively analyzed. All the patients underwent preoperative lymphadenectomy. In the latter part of the prospective study, The hospital from July 2007 to November 2009 received SLNB of 565 cases of breast cancer patients were randomly divided into preoperative lymphatic imaging group and non-lymphoscintigraphy group. Results The retrospective study showed that the success rate of preoperative lymphadenectomy was 86.6%, which was only significantly related to the pathological status of axillary lymph nodes (P = 0.003). The difference of success rate of nuclide SLNB between preoperative axillary lymph imaging and success (P <0.001). However, there was no significant difference in nuclide SLNB false negative rate, combined SLNB success rate and false negative rate (P = 0.731, P = 0.174, P = 0.947). There was no significant difference in the success rates and false-negative rates of SLNB and the success rate of SLNB and false negative rate in the preoperative lymphadenectomy group (82.1% imaging success) and non-lymphatic imaging group P = 0.757, P = 1.00, P = 1.00, P = 1.00, respectively). Conclusion Preoperative lymphadenectomy can not improve the success rate of SLNB, nor can it reduce the false negative rate. Lymphoscintigraphy can not be performed before breast cancer SLNB in clinical practice. Intraoperative combination of blue dye and γ detector can be accurately performed SLNB.