摘要
目的:探讨乳腺癌前哨淋巴结(SLN)解剖学定位与传统解剖学淋巴结转移规律的相关性,进一步验证SLN在指导乳腺癌腋淋巴结清除范围中的地位。方法:对109例cN0期乳腺癌患者行染料法联合核素法检测SLN。术前6～16h将99mTc标记的硫胶体注射在原发肿瘤周围表面的皮下组织,术前15min将1%亚甲蓝2mL注射于肿瘤对角线相应部位的皮下组织内(62例)或乳晕皮下组织内(47例)。行SLNB后再行全腋窝淋巴结(43例)或中低位腋窝淋巴结清除术(66例),标本行常规HE染色组织学检查。结果:107例患者成功检测出SLN,染料法与核素法的成功率均为96.33%(105/109),联合检测的成功率为98.17%(107/109),共检出SLN205枚,平均每例患者检出1.92枚,其中SLN位于胸大肌外侧缘(LevelⅠ)101例,位于胸小肌深面(LevelⅡ)2例,同时位于LevelⅠ及LevelⅡ3例,同时位于LevelⅠ及胸骨旁1例。所有成功病例核素标识出的SLN与染料标识的SLN完全吻合(100%,105/105)。结论:SLN可能是乳房整个器官的SLN,而非乳房某个具体部位的SLN,SLN定位是固定的;将示踪剂注射于乳腺腺体表面皮下组织,"单点"注射对标识的成功率没有影响;假阴性率及跳跃转移现象是存在的;内乳淋巴结是否乳腺癌转移的第一站,尚需要在设备的改进与更多的研究方向做出定论。
OBJECTIVE：To discuss the correlation between the location of sentinel lymph node （SLN） and traditional anatomy,and verify the significance of sentinel lymph node biopsy（SLNB） in guiding the lymph node cleaning range in patients with breast cancer.METHODS：From Dec.2007 to Dec.2009,SLNB was performed on 109 patients with cN0 breast cancer by combination of nuclide and blue dye.The nuclide of 99mTc labeled sulfur colloid was injected subcutaneously around the primary tumor 6 to 16 hours before operation,while methylene blue（1%,2 mL） was injected in the diagonal quadrant region （62 cases） and subareola （47 cases） 15 minutes before operation.Axillary lymph node dissection（ALND） of whole ALN （43 cases） and middle-inferior ALN （66 cases） was performed following SLNB.RESULTS：The success rate of SLNB was 98.17%（107/109） by combination method,and both 96.33%（105/109） by single isotope tracer and by single blue dye,respectively.There were 205 SLNs detected altogether and 1.92 SLNs per patient.The SLNs located in the outside of pectoralis major（Level Ⅰ） in 101cases,in the inside of pectoralis minor（Level Ⅱ） in 2cases,in Level Ⅰ and Ⅱ simultaneously in 3 cases,in Level Ⅰ and parasternal area in 1 case.The SLNs detected by sulfur colloid and blue dye were identical（100%,105/105）.CONCLUSIONS：The identification of SLNs were independent of injection site of the tracer.The location of breast cancer does not affect the location of SLN.SLN is related to whole breast rather than some specific site of the breast.Axillary lymph node metastasis skipping phenomenon do exist in breast cancer.The ＂bit＂ injection has no effect on the marking success rate.It should be proved by more research that whether internal mammary node is the first site of metastasis.
出处
《中华肿瘤防治杂志》
CAS
2010年第14期1100-1103,共4页
Chinese Journal of Cancer Prevention and Treatment
