乳腺癌新术式及前哨淋巴结检测的临床研究
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摘要
目的:设计并临床验证乳腺癌腋窝及锁骨下逆行淋巴结清扫法的临床可行性;用美蓝标记前哨淋巴结并与逆行淋巴结清扫法所得结果全面比较,分析染料法的可靠性和临床检测价值;同时探索保乳手术的实施策略。
资料和方法:对2002年10月～2005年3月期间的78例女性乳腺癌住院病人利用美蓝标记法检测了前哨淋巴结,全部78例均采用逆行腋窝及锁骨下淋巴结清扫法进行引流区域的淋巴结清扫,其中42例施行了保乳手术,另36例施行了改良根治术,78例手术切除标本(乳腺及淋巴结)均送病理检查,所得结果与临床相关资料(患者年龄、肿块部位、大小、及淋巴结状况等)进行综合对比分析,针对不同的乳腺癌病例作上述各方面的关联分析。
结果:保留乳房的42例中经病理证实9例有淋巴结转移,未保留乳房的36例中有19例发现淋巴结转移。78例美蓝染色后有8例腋窝未发现蓝染的淋巴结,发现3例为跳跃性转移淋巴结(其中2例为保乳手术病例)。前哨淋巴结的检出率为89.7%。逆行腋淋巴结清扫的78例中未出现任何神经、血管损伤等并发症,术后恢复顺利,全部病例已随访3月～29月,尚未见任何一例复发和转移,也未发现上肢疼痛、肿胀等并发症。
结论:1、逆行腋淋巴结清扫法,对各组淋巴结显露清晰,能全面掌
Objective: To design and clinically verify the feasibility of inverse lymph node dissection and compare the results of sentinel nodes dyed with methylene blue and those of inverse lymph node dissection of fossa axillary and subclavicular, at the same time,to investigate the practical strategies of breast conservation therapy.Method: Clinical and pathological relations of sentinel nodes dyed with methylene blue in 78 in-patient invasive ductal breast cancer cases admitted from Oct.2002 to Mar.2005 were compared. All the lymph nodes of drainage area were removed with inverse lymph node dissection method. 42 patients were received breast conservation therapy and the other 36 patients were received modified radical mastectomy. Samples (breast or lymph nodes) in 78 cases were examined pathologically. Pathological diagnoses and clinical data (age, tumor site, tumor size and lymph nodes) were comprehensively analyzed. Relative analyses were made for different breast cancers.Results: 9 in 42 patients received breast conservation therapy had lymph node metastases. 19 in 36 patients received mastectomy had lymph node metastases. 3 in 8 patients whose Axillary lymph nodes were methylene blue negatively-dyed, had saltatory blue-dyeing and were proofed metastatic. Discovering rate of sentinel nodes was 89.7%. There were no complications such as nerve and vessel damage in 78 cases. All of the patients have been
followed up from 3 to 29 months, without metastasis, recurrence, pain or lymphedema of upper extremeties.Conclusion: 1. Inverse lymph node dissection is feasible without limitations by age, breast conservation or mastectomy and tumor site. It is suitable for multiplicate kinds of operation aimed at conserving pectoral muscle or/and breast. This kind of operation can completely control all regional lymph nodes, which is hepfiil for doctors to determine comprehensive treatment for breast cancer patients. 2.Sentinel lymph nodes were examined using methylene blue dyeing, with discovering rate 89.7%(70/78), skip metastasis rate 3.8%(3/78). Inverse lymph node dissection can make up false negativeness and saltatory metastasis which may be missed by sentinel node biopsy. It is especially useful to breast conservation surgery. 3. Inverse lymph node dissection during breast cancer operation can completely conserve pectoral muscle, clearly show all axillary lymph nodes and is easily manipulated. This type of operation has not be seen before within homeland.
资料和方法:对2002年10月～2005年3月期间的78例女性乳腺癌住院病人利用美蓝标记法检测了前哨淋巴结,全部78例均采用逆行腋窝及锁骨下淋巴结清扫法进行引流区域的淋巴结清扫,其中42例施行了保乳手术,另36例施行了改良根治术,78例手术切除标本(乳腺及淋巴结)均送病理检查,所得结果与临床相关资料(患者年龄、肿块部位、大小、及淋巴结状况等)进行综合对比分析,针对不同的乳腺癌病例作上述各方面的关联分析。
结果:保留乳房的42例中经病理证实9例有淋巴结转移,未保留乳房的36例中有19例发现淋巴结转移。78例美蓝染色后有8例腋窝未发现蓝染的淋巴结,发现3例为跳跃性转移淋巴结(其中2例为保乳手术病例)。前哨淋巴结的检出率为89.7%。逆行腋淋巴结清扫的78例中未出现任何神经、血管损伤等并发症,术后恢复顺利,全部病例已随访3月～29月,尚未见任何一例复发和转移,也未发现上肢疼痛、肿胀等并发症。
结论:1、逆行腋淋巴结清扫法,对各组淋巴结显露清晰,能全面掌
Objective: To design and clinically verify the feasibility of inverse lymph node dissection and compare the results of sentinel nodes dyed with methylene blue and those of inverse lymph node dissection of fossa axillary and subclavicular, at the same time,to investigate the practical strategies of breast conservation therapy.Method: Clinical and pathological relations of sentinel nodes dyed with methylene blue in 78 in-patient invasive ductal breast cancer cases admitted from Oct.2002 to Mar.2005 were compared. All the lymph nodes of drainage area were removed with inverse lymph node dissection method. 42 patients were received breast conservation therapy and the other 36 patients were received modified radical mastectomy. Samples (breast or lymph nodes) in 78 cases were examined pathologically. Pathological diagnoses and clinical data (age, tumor site, tumor size and lymph nodes) were comprehensively analyzed. Relative analyses were made for different breast cancers.Results: 9 in 42 patients received breast conservation therapy had lymph node metastases. 19 in 36 patients received mastectomy had lymph node metastases. 3 in 8 patients whose Axillary lymph nodes were methylene blue negatively-dyed, had saltatory blue-dyeing and were proofed metastatic. Discovering rate of sentinel nodes was 89.7%. There were no complications such as nerve and vessel damage in 78 cases. All of the patients have been
followed up from 3 to 29 months, without metastasis, recurrence, pain or lymphedema of upper extremeties.Conclusion: 1. Inverse lymph node dissection is feasible without limitations by age, breast conservation or mastectomy and tumor site. It is suitable for multiplicate kinds of operation aimed at conserving pectoral muscle or/and breast. This kind of operation can completely control all regional lymph nodes, which is hepfiil for doctors to determine comprehensive treatment for breast cancer patients. 2.Sentinel lymph nodes were examined using methylene blue dyeing, with discovering rate 89.7%(70/78), skip metastasis rate 3.8%(3/78). Inverse lymph node dissection can make up false negativeness and saltatory metastasis which may be missed by sentinel node biopsy. It is especially useful to breast conservation surgery. 3. Inverse lymph node dissection during breast cancer operation can completely conserve pectoral muscle, clearly show all axillary lymph nodes and is easily manipulated. This type of operation has not be seen before within homeland.
引文
1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty- year follow-up of a randomimzed study comparing breast cancer-conserving surgery with radical mastectomg for early breast cancer N Engl J Med, 2002, 347: 1227-1232.
2. Fisher B, Anderson S, Bryant J. et al. Twenty-year follow-up of a randomized trial comparing total mastectomg, lumpectomy, and lumpectomy plus irradiatin for the treat ment of invasive breast cancer. N Engl J Med, 2002, 347: 1233-1241.
3. Noguchi M, Motomura K, Imoto S et al.: A muiticenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society, Breast Cancer Res Treat 2000; 63: 31-40
4.野口昌邦:乳癌外科最前線,东京,金原出版株式会社,2004,14-27。
5. The Japanese Breast Cancer Society: Results of questionnaires conceming breast cancer surgery in Japan: an update in 2000, Breast Cancer 2002, 9: 1-3.
6.孙哲、梁洪伟、徐惠绵:早期乳腺癌保乳治疗的研究进展,国外医学肿瘤学分册 2005;32:41-44.
7.沈镇宙 张亚伟.乳腺癌术式的演变,临床外科杂志.2000,8(5):260-261
8.大川智彦,児玉宏,秋山 太:乳房温存療法(1999)乳癌临床 2000,15:147-156
9.David C.Sabiston Jr主编,王德炳主译,克氏外科学,第15版,北京,人民卫生出版社 2000,459-497。
10.野口昌邦:乳癌外科最前線,东京,金原出版株式会社,2004,28-40。
11.三濑圭一、児玉宏:腋窝锁骨下節郭清,手術,2000,54:1383-1388
12. Hughes KS, Schnaper LA, Perry D. et al. Lumpectomy plus Tamoxifen with or without Irradiation in women 70years of Age or older with Early Breast Cancer. N Engl J Med. 2004; 351: 971-977.
13. Ruo Redda MG, Verna R, Guarneri A. et al. Timing of radio therapy in breast cancer conserving treatment, [J]: Cancer Treat Rev. 2002, 28: 5-10.
2. Fisher B, Anderson S, Bryant J. et al. Twenty-year follow-up of a randomized trial comparing total mastectomg, lumpectomy, and lumpectomy plus irradiatin for the treat ment of invasive breast cancer. N Engl J Med, 2002, 347: 1233-1241.
3. Noguchi M, Motomura K, Imoto S et al.: A muiticenter validation study of sentinel lymph node biopsy by the Japanese Breast Cancer Society, Breast Cancer Res Treat 2000; 63: 31-40
4.野口昌邦:乳癌外科最前線,东京,金原出版株式会社,2004,14-27。
5. The Japanese Breast Cancer Society: Results of questionnaires conceming breast cancer surgery in Japan: an update in 2000, Breast Cancer 2002, 9: 1-3.
6.孙哲、梁洪伟、徐惠绵:早期乳腺癌保乳治疗的研究进展,国外医学肿瘤学分册 2005;32:41-44.
7.沈镇宙 张亚伟.乳腺癌术式的演变,临床外科杂志.2000,8(5):260-261
8.大川智彦,児玉宏,秋山 太:乳房温存療法(1999)乳癌临床 2000,15:147-156
9.David C.Sabiston Jr主编,王德炳主译,克氏外科学,第15版,北京,人民卫生出版社 2000,459-497。
10.野口昌邦:乳癌外科最前線,东京,金原出版株式会社,2004,28-40。
11.三濑圭一、児玉宏:腋窝锁骨下節郭清,手術,2000,54:1383-1388
12. Hughes KS, Schnaper LA, Perry D. et al. Lumpectomy plus Tamoxifen with or without Irradiation in women 70years of Age or older with Early Breast Cancer. N Engl J Med. 2004; 351: 971-977.
13. Ruo Redda MG, Verna R, Guarneri A. et al. Timing of radio therapy in breast cancer conserving treatment, [J]: Cancer Treat Rev. 2002, 28: 5-10.