目的

探讨乳腺癌时乳腺淋巴引流的特点。

方法

以2004年11月至2006年5月期间住院的206 例乳腺癌患者为研究对象,其中191 例术前行淋巴闪烁显像。 用前哨淋巴结活检和腋窝溶脂后腔镜观察联合验证淋巴闪烁显像所见的乳腺淋巴引流途径和前哨淋巴结。

结果

肿瘤周围腺体实质和肿瘤被覆皮下联合注射示踪剂内乳前哨淋巴结显示率为46.8%。 淋巴显像、前哨淋巴结活检和腋窝溶脂后腔镜3 种方法联合观察发现乳腺淋巴经不同输入淋巴管直接引流到腋窝或内乳区;腋窝前哨淋巴结位于第2 肋骨与胸大肌外缘交界处周围,少数患者有浅、深两组腋窝前哨淋巴结。 内乳淋巴结转移率为26.2%,腋窝淋巴结转移≥4 枚时内乳转移率为50.7%。 第2 肋间隙是内乳淋巴结最常见的转移部位。内乳淋巴结转移与肿瘤部位或大小无显著相关性。

结论

乳腺实质及皮肤的淋巴沿各自的集合淋巴管不经乳晕淋巴丛而直接汇入腋窝或内乳淋巴结;多数患者不同的淋巴管在腋窝汇入同一前哨淋巴结,少数汇入深浅不同组前哨淋巴结。 有选择地行内乳淋巴结活检有助于乳腺癌的精确分期、治疗和预后判断。

Objective

To explore the features of lymphatic drainage patterns of breast cancer under physiologic conditions.

Methods

From Nov 2004 to May 2005, there were 206 consecutive patients enrolled in this study, 191 of them received preoperative lymphoscintigraphy. Sentinel lymph node biopsy and endoscopic approach after liposuction were used to prove the lymphatic drainage pathways and sentinel lymph nodes.

Results

Internal mammary sentinel nodes were revealed in 74 patients (46. 84%) who had received peritumoral and subdermal injections of radiolabeled tracer by lymphoscintigraphic scanning. The surveys by lymphoscintigraphy,sentinel node biopsy and endoscopic approach after liposuction proved that the lymph from breast parenchymal tissue or the skin and subdermal tissue flowed directly to the axillary basin or internal mammary nodal basin, the axillary sentinel nodes were situated in the same intersection of the second costal bone and the margin of major pectoral muscle, and the axillary sentinel nodes in some patients were composed of the superficial group and the profound group. The overall frequency of internal mammary node metastases in breast cancer was 26.6%. The frequency in patients with ≥4 positive axillary nodes was 50. 7%. The metastatic internal mammary nodes appeared in the second intercostal space with a high frequency. There was no statistic relation between internal mammary nodes metastases and tumor location or tumor size.

Conclusion

Most lymph from the parenchymal tissue and the skin of the breast flows directly to the axillary and internal mammary nodal basins, and does not pass through the subareolar plexus. The deep and superficial collecting lymphatic vessels mostly run to the same axillary sentinel node in most patients, and may drain to the superficial and profound sentinel nodes. Internal mammary node biopsy is necessary for selected cases to provide information for accurate stage, treatment and prognosis of breast cancer.