术前超声结合术中淋巴引流导向的乳腺癌精准前哨淋巴结活检

doi:10.6040/j.issn.1671-7554.0.2017.1115

摘要/Abstract

摘要： 目的从术前到术中全程监测前哨淋巴结活检(SLNB),实现精准化治疗并确定其临床应用价值。方法术前超声评估患者腋窝淋巴结状态,定位靠近乳房及异常肿大淋巴结。术中采用亚甲蓝及吲哚菁绿(ICG)双标法显影淋巴管和淋巴结,准确区分真正的前哨淋巴结(trSLN)、前哨旁淋巴结(paSLN)和前哨后淋巴结(poSLN),并仅对trSLN进行切除活检。结果通过评估126例乳腺癌患者,术前超声诊断符合率为78.8%;SLNB特异度、灵敏度、假阴性率(FNR)分别为100%、88.1%、11.9%;多灶性肿瘤假阴性差异有统计学意义(P=0.009),而术前评估淋巴结状态及paSLN是否转移对假阴性的影响差异无统计学意义。结论结合术前超声评估定位,术中淋巴引流导向的SLNB可实现低创伤、低FNR,多灶性肿瘤是假阴性的危险因素。

关键词: 前哨淋巴结, 淋巴引流, 超声, 活检, 乳腺癌

Abstract: Objective Sentinel lymph node biopsy(SLNB)was monitored during the complete surgical procedures to achieve accurate treatment and to determine its clinical value. Methods Axillary lymph nodes were assessed by ultrasound before operation. The lymph nodes near breast which were abnormally enlarged were marked. Intraoperatively, the lymph vessels and nodes were stained with both methylene blue and indocyanine green(ICG). After the true sentinel lymph nodes(trSLNs), para-SLNs(paSLNs)and post-SLNs(poSLNs)were accurately distinguished, the trSLNs were resected for biopsy. Results The evaluation of 126 cases of breast cancer revealed that the coincidence rate of preoperative ultrasound diagnosis was 78.8%. The SLNB specificity, sensitivity, and false negative rate(FNR)were 100%, 88.1% and 11.9%, respectively. The false negative of multifocal tumor was statistically significant(P=0.009), while preoperative assessment of lymph node status and paSLN metastasis were not statistically significant. Conclusion Preoperative ultrasound localization combined with intraoperative drainage guided SLNB can cause few trauma and low false negative rate. Multifocal tumor is a risk factor of false negative.

Key words: Sentinel lymph node, Lymphatic drainage, Ultrasound, Biopsy, Breast cancer

中图分类号:

R615

陈思思,李小燕,江立玉,孔晓丽,马婷婷,杨其峰. 术前超声结合术中淋巴引流导向的乳腺癌精准前哨淋巴结活检[J]. 山东大学学报 (医学版), 2018, 56(1): 50-56.

CHEN Sisi, LI Xiaoyan, JIANG Liyu, KONG Xiaoli, MA Tingting, YANG Qifeng. Precise sentinel lymph node biopsy in breast cancer guided by preoperative ultrasound combined with intraoperative lymphatic drainage[J]. Journal of Shandong University (Health Sciences), 2018, 56(1): 50-56.

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