乳腺癌前哨淋巴结检测及其临床意义
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摘要
目的探讨乳腺癌前哨淋巴结检测及其淋巴结转移的临床意义。方法以2014年3月-2016年3月广西医科大学第一附属医院收治的141例乳腺癌患者为对象,患者入院后均行前哨淋巴结活检,而后行常规改良根治术或根治术治疗,标本切除后送病理检查,术后病理切片检查前哨淋巴结和手术切除标本。结果 141例乳腺癌中,共有138例患者检出前哨淋巴结,前哨淋巴结检出率为97.87%(138/141);与术后病理结果对照,前哨淋巴结检出准确率为97.83%、敏感度为98.48%、假阴性率为6.06%;141例患者穿刺活检确定淋巴结转移或前哨活检阳性但未清扫者共60例,病理确诊腋窝转移共60例,病情进展15例;而术后随访结果证实前哨淋巴结活检可准确判断腋窝转移情况。结论乳腺癌前哨淋巴结检测可明确评估乳腺癌患者腋窝淋巴结是否转移,对指导临床合理手术方案的制定及评估预后效果方面有着重要临床意义。
Objective To investigate the detection of sentinel lymph nodes and lymphatic metastasis of breast cancer and its clinical significance. Methods One hundred and forty-one cases of patients with breast cancer treated in the First Affiliated Hospital of Guangxi Medical University between March 2014 and March 2016 were enrolled in the study. All the patients underwent sentinel lymph node biopsy after admission before they were treated with routine radical mastectomy or radical mastectomy.The removed samples were collected for pathological examination. The sentinel lymph nodes and surgically removed samples were examined through postoperative pathological sections.Results Sentinel lymph nodes were detected in 138 of the 141 patients with breast cancer,and the detection rate of sentinel lymph nodes was 97.87%( 138/141). Compared with the postoperative pathological findings,the accuracy,sensitivity and the false negative rate of detection for sentinel lymph nodes were 97.83%,98.48% and 6.06%,respectively. Among the 141 patients,a total of 60 patients had lymph node metastasis confirmed by biopsy or sentinel biopsy,but the lymph node metastases were not cleaned. Pathologically diagnosed axillary metastases were detected in 60 cases,and the disease progressed in 15 cases. The postoperative follow-up results confirmed that the sentinel lymph node biopsy could help determine axillary metastases accurately. Conclusion The detection of sentinel lymph node of breast cancer can help diagnose the status of axillary lymph node metastasis of breast cancer,which is of great clinical significance for selecting the right approach and evaluating the prognosis.
Objective To investigate the detection of sentinel lymph nodes and lymphatic metastasis of breast cancer and its clinical significance. Methods One hundred and forty-one cases of patients with breast cancer treated in the First Affiliated Hospital of Guangxi Medical University between March 2014 and March 2016 were enrolled in the study. All the patients underwent sentinel lymph node biopsy after admission before they were treated with routine radical mastectomy or radical mastectomy.The removed samples were collected for pathological examination. The sentinel lymph nodes and surgically removed samples were examined through postoperative pathological sections.Results Sentinel lymph nodes were detected in 138 of the 141 patients with breast cancer,and the detection rate of sentinel lymph nodes was 97.87%( 138/141). Compared with the postoperative pathological findings,the accuracy,sensitivity and the false negative rate of detection for sentinel lymph nodes were 97.83%,98.48% and 6.06%,respectively. Among the 141 patients,a total of 60 patients had lymph node metastasis confirmed by biopsy or sentinel biopsy,but the lymph node metastases were not cleaned. Pathologically diagnosed axillary metastases were detected in 60 cases,and the disease progressed in 15 cases. The postoperative follow-up results confirmed that the sentinel lymph node biopsy could help determine axillary metastases accurately. Conclusion The detection of sentinel lymph node of breast cancer can help diagnose the status of axillary lymph node metastasis of breast cancer,which is of great clinical significance for selecting the right approach and evaluating the prognosis.
引文
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[12]巫姜,赵戈,崔风强,等.前哨淋巴结活检联合术前超声在老年乳腺癌腋窝淋巴结清扫中的价值[J].现代肿瘤医学,2016,24(4):551.
[13]NENKOV R,RADEV R,MADZHOV R,et al.Sentinel lymph node biopsy in patients with papillary thyroid carcinoma[J].Khirurgiia,2015,92(11):2868.
[14]张迪,吕青.乳腺癌前哨淋巴结微小转移灶的预后意义及临床处理[J].中华乳腺病杂志(电子版),2016,10(2):109.
[15]冯宇,赵霞,吕淑贞,等.腋窝前哨淋巴结活检在原发性乳腺癌患者中的应用价值[J].山东医药,2016,56(16):68.
[2]李旻,谢博遥,何国栋,等.术中细胞学印片法诊断乳腺癌前哨淋巴结转移的准确性分析[J].临床肿瘤学杂志,2016,21(10):919.
[3]李盼盼,王永胜.乳腺癌前哨淋巴结活检术新型示踪剂的研究进展[J].中国癌症杂志,2016,26(12):1031.
[4]叶春梅,熊斌,胡俊波,等.量子点技术检测乳腺癌前哨淋巴结转移的研究[J].中华实验外科杂志,2016,33(7):1826.
[5]张彦收,刘运江.乳腺癌手术治疗回顾和进展[J].现代肿瘤医学,2015,32(5):719.
[6]BUGLIONI S,TERRENATO I,CASINI B,et al.P011 A new clinical cut-off of cytokeratin 19 mRNA copy number in sentinel lymph node of breast cancer[J].Breast,2015,24(12):S29.
[7]雷海,黄晓蓉,闫珊玲,等.荧光联合染料染色在乳腺癌前哨淋巴结活检中的应用研究[J].中国综合临床,2015,31(12):1067.
[8]赵艳生,刘晓安.乳腺癌前哨淋巴结活检假阴性原因分析[J].中华内分泌外科杂志,2015,28(2):114.
[9]陈基施展,吴克瑾.乳腺癌前哨淋巴结活检假阴性临床研究进展[J].中国实用外科杂志,2015,35(7):787.
[10]MONCAYO V M,AARSVOLD J N,ALAZRAKI N P.Lymphoscintigraphy and sentinel nodes[J],J Nucl Med,2015,56(6):901.
[11]韩超,郑刚,左文述.乳腺癌前哨淋巴结活检假阴性相关因素与对策的研究现状[J].肿瘤,2016,36(5):585.
[12]巫姜,赵戈,崔风强,等.前哨淋巴结活检联合术前超声在老年乳腺癌腋窝淋巴结清扫中的价值[J].现代肿瘤医学,2016,24(4):551.
[13]NENKOV R,RADEV R,MADZHOV R,et al.Sentinel lymph node biopsy in patients with papillary thyroid carcinoma[J].Khirurgiia,2015,92(11):2868.
[14]张迪,吕青.乳腺癌前哨淋巴结微小转移灶的预后意义及临床处理[J].中华乳腺病杂志(电子版),2016,10(2):109.
[15]冯宇,赵霞,吕淑贞,等.腋窝前哨淋巴结活检在原发性乳腺癌患者中的应用价值[J].山东医药,2016,56(16):68.