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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2008, Vol. 02 ›› Issue (02) : 18 -21. doi: 10.3877/cma.j.issn.1674-0807.2008.02.005

临床研究

术前淋巴显像在乳腺癌前哨淋巴结活检中的作用
王磊1, 胡旭东1, 李济宇1, 陈鸣陆1, 杨国仁1, 刘岩松1, 周正波1, 李永清1, 刘雁冰1, 赵桐1, 陈鹏1, 左文述1, 王永胜1,†()   
  1. 1.250117 济南,山东省肿瘤医院乳腺疾病中心
  • 收稿日期:2007-09-07 出版日期:2008-04-01
  • 通信作者: 王永胜

Role of lymphoscintigraphy in sentinel lymph node biopsy in breast cancer patients

Lei WANG1, Xu-dong HU1, Ji-yu LI1, Ming-lu CHEN1, Guo-ren YANG1, Yan-song LIU1, Zheng-bo ZHOU1, Yong-qing LI1, Yan-bing LIU1, Tong ZHAO1, Peng CHEN1, Wen-shu ZUO1, Yong-sheng WANG†,1()   

  1. 1.Breast Disease Center, Shandong Cancer Hospital, Jinan 250117, China
  • Received:2007-09-07 Published:2008-04-01
  • Corresponding author: Yong-sheng WANG
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王磊, 胡旭东, 李济宇, 陈鸣陆, 杨国仁, 刘岩松, 周正波, 李永清, 刘雁冰, 赵桐, 陈鹏, 左文述, 王永胜. 术前淋巴显像在乳腺癌前哨淋巴结活检中的作用[J/OL]. 中华乳腺病杂志(电子版), 2008, 02(02): 18-21.

Lei WANG, Xu-dong HU, Ji-yu LI, Ming-lu CHEN, Guo-ren YANG, Yan-song LIU, Zheng-bo ZHOU, Yong-qing LI, Yan-bing LIU, Tong ZHAO, Peng CHEN, Wen-shu ZUO, Yong-sheng WANG. Role of lymphoscintigraphy in sentinel lymph node biopsy in breast cancer patients[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2008, 02(02): 18-21.

目的

探讨术前淋巴显像在乳腺癌前哨淋巴结活检(sentinel lymph node biopsy, SLNB)中的作用。

方法

回顾性分析了716 例联合术前淋巴显像与术中γ 探测仪和蓝染料检测乳腺癌SLNB 的结果。

结果

全组SLNB 成功率98. 2% (703/716),验证组SLNB 的假阴性率16. 0%(15/94)。 淋巴显像共成功地确定出620 例患者(86.6%)的前哨淋巴结(sentinel lymph node,SLN),并在36 例患者(5.0%)中发现了腋窝以外的前哨淋巴结。 淋巴显像确定SLN 的失败率与原发肿瘤的部位、肿瘤的病理类型和注射同位素到显像的时间无显著相关性(均P ＞0.05)。 注射示踪剂前已进行肿瘤切除活检的患者,其淋巴显像成功率低于未行肿瘤切除活检者; 淋巴结转移患者淋巴显像的成功率低于淋巴结阴性患者。 术中确定SLN 的成功率在术前淋巴显像成功组和失败组之间存在显著的统计学差异(99.5% vs 91.0%,P ＜0.01)。 术前淋巴显像是否成功确定SLN 与SLNB 的假阴性率无显著相关性(P=0.731)。

结论

乳腺癌SLN 术前淋巴显像可以预测术中SLNB 的成功率,同时术前淋巴显像有助于确定腋窝以外的SLN,但术前淋巴显像并非乳腺癌SLNB 所必需。

关键词: 乳腺肿瘤, 前哨淋巴结活检, 淋巴显像

Objective

To explore the role of lymphoscintigraphy in sentinel lymph node biopsy(SLNB) in breast cancer patients.

Methods

We retrospectively analyzed 716 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB in our database.

Results

The success rate of sentinel lymph node biopsy (SLNB) was 98.2% (703/716). The false negative rate of SLNB was 16.0% (15/94). Among all the patients, sentinel lymph nodes ( SLN) were well imaged by lymphoscintigraphy in 86.6% patients,and SLNs were found at extra-axilla in 36 patients.The visualization of SLN in lymphoscintigraphy was not associated with histopathologic type,the location and stage of primary tumor and time interval from injection of radiocolliod to surgery. However,the negative lymphoscintigraphy results were associated with excision biopsy before injection of radiocolliod and axillary node metastases.Failure of surgical identification of axillary SLN was associated with the imaging of hot spot by lymphoscintigraphy. There was no significant difference in the false negative rate between patients who had axillary hot spot in lymphoscintigram and those who did not have (P=0.731).

Conclusions

Visualization of SLN in preoperative lymphoscintigraphy predicts the successful SLN identification.Moreover,preoperative lymphoscintigraphy is helpful in identification of extra-axillary sentinel nodes.However,it is not necessary in sentinel lymph nodes biopsy in breast cancer.

Key words: Breast neoplasmas, Sentinel lymph node biopsy, lymphoscintigraphy
表1 淋巴显像所示前哨淋巴结的部位
术前前哨淋巴结显像结果 患者数 百分率(%)
无 96 13.4
仅腋窝 584 81.6
仅内乳区 12 1.7
腋窝+内乳区 15 2.1
仅锁骨上 1 0.1
腋窝+锁骨上 4 0.6
上腹部 2 0.3
腋窝+上腹部 2 0.3
合计 716 100
表2 入组患者的临床病理特征和术前淋巴显像的结果
临床病理特征 前哨淋巴结显像例数(%) 前哨淋巴结未显像例数(%) P值
病理类型 0.299
　非浸润性癌 43(95.6%) 2(4.4%)
　浸润性导管癌 379(86.3%) 60(13.7%)
　浸润性小叶癌 100(85.5%) 17(14.5%)
　符合癌 47(85.5%) 8(14.5%)
　其他 51(85.0%) 9(15.0%)
原发肿瘤部位 0.299
　外上象限 370(86.0%) 60(14.9%)
　内上象限 112(83.6%) 22(14.4%)
　外下象限 70(93.3%) 5(6.7%)
　内下象限 28(84.8%) 5(15.2%)
　中央区 40(90.9%) 4(9.1%)
注射到显像时间 0.632
　＞9h 268(85.9%) 44(14.1%)
　≤9h 352(87.1%) 52(12.9%)
注射示踪剂时间 0.002
　活检前注射 379(90.0%) 42(10.0%)
　活检后注射 241(81.7%) 54(18.3%)
腋窝淋巴结状态 0.004
　阳性 200(81.3%) 46(18.7%)
　阴性 420(89.4%) 50(10.6%)
患者平均年龄/岁 45.6 46.9 0.247
原发肿瘤平均大小/cm 2.5 2.5 0.987
图1 术前淋巴显像示例 R:右侧;L:左侧;ANT:前视图;A:前;P:后; LL:左侧视图;SLN:前哨淋巴结;INJSPOT:注射部位
表3 术前淋巴显像确定前哨淋巴结与术中联合蓝染料确定前哨淋巴结成功率的关系
术前腋窝前哨淋巴结显像 前哨淋巴结活检 P
成功 失败
成功 602 3 ＜0.01
失败 101 10
合计 703 13
表4 术前淋巴显像对前哨淋巴结活检假阴性率的影响
术前腋窝前哨淋巴结显像 前哨淋巴结活检假阴性 P
否 是
成功 63 11 0.731
失败 16 4
合计 79 15
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