目的

探讨乳晕下联合注射核素和美蓝行前哨淋巴结活检的可行性。

方法

选择2004 年10 月至2007 年2 月早期乳腺癌患者195 例,将患者抽签随机分为两组:一组将示踪剂注射在肿瘤周围(肿瘤周围组);另一组将示踪剂注射在乳晕下(乳晕下组)。 对所有患者均先行前哨淋巴结活检,再行腋窝淋巴结清扫。 将所有的前哨淋巴结和非前哨淋巴结均进行常规切片和HE 染色检查,对常规病理检查阴性的前哨淋巴结行多层切片和免疫组化检查。

结果

全组195 例,肿瘤周围组98 例,乳晕下组97 例。 肿瘤周围组与乳晕下组前哨淋巴结活检成功率分别为92.9%和97.9%(P =0.17)。 经常规病理检查或多层切片加免疫组化检查后,肿瘤周围组有25 例SLN 阳性,乳晕下组29 例SLN 阳性。 经腋窝淋巴结清扫后,肿瘤周围组有2 例SLN 为假阴性,假阴性率为7.4%(2/27),乳晕下组有3 例假阴性,假阴性率为9.4%(3/32),两组间差异无统计学意义。 肿瘤周围组和乳晕下组对腋窝淋巴结预测的准确度分别为97.8%和96.8%,灵敏度分别为92.6%和90.6%,差异均无统计学意义。

结论

乳晕下注射两种示踪剂行前哨淋巴结活检与肿瘤周围注射相比具有同样预测腋窝淋巴结状况的准确性,同时能避免肿瘤周围注射存在的缺点,是较佳的注射途径。

Objective

To compare the results of SLNB by peritumoral and subareolar injection routes and to explore the feasibility of subareolar injection route for breast cancer SLNB.

Methods

From Oct. 2004 to Feb. 2007,195 patients with early stage breast cancer were divived randomly into two groups. In one group(the PT group), peritumoral injection of ^99mTc sulfur colloid and methylene blue was performed; in the other group(the SA group), subareolar injection of the same tracers was performed. In all patients, complete axillary lymph node dissection was performed. All SLNs and non-SLNs were subjected separately to routine pathological examnation. The SLNs of tumor-negative were paraffin embedded, sectioned and stained with immunohistochemical stain.

Results

In the 195 patients, peritumoral injection was performed in 98 patients and subareolar injection in 97 patients . Routine pathological and immunohistochemical examinations showed positive SLN in 25 cases in the PT group and in 29 cases in the SA group. The success rate of identifying SLN was 92.9% in the PT group and 97.9% in the SA group (P =0.17). The false negative rate was 7.4%(2/27) in the PT group and 9.4%(3/32) in the SA group (P =1). The overall accuracy of detecting SLN was 97.8% and 96.8% (P =1), and the sensitivity was 92.6% and 90.6% in the PT group and the SA group separately (P=1.000).

Conclusions

Subareolar injection of tracers has the same accuracy of detecting axillary lymph node status as peritumoral injection route, and avoids demerits from peritumoral injection.Subareolar injection route is an optimal way of administrating tracers for SLN mapping and biopsy in breast cancer.