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前哨淋巴结(sentinel lymph node, SLN)是淋巴回流的第一站淋巴结, 准确检测SLN对肿瘤的分期、外科手术方式的选择及预后的判断有重要意义。近年来越来越多的研究提示, 如果乳腺癌SLN未转移, 可不必行腋窝淋巴清扫术, 因此探测乳腺癌SLN是否转移的成功率和准确性非常重要。本研究回顾性分析应用99Tcm-硫胶体示踪法及联用99Tcm-硫胶体与亚甲蓝染色法探测早期乳腺癌SLN的效果。现报道如下。
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76例患者中有74例成功探测到SLN, 检出率97.4%, 最多1例检出SLN 6个, 平均2.0个; 共切除SLN 118个, ALN 684个。
单用99Tcm-硫胶体组25例中, 探测到SLN 23例, 9例SLN阳性(其中有1例仅SLN阳性); 14例SLN阴性(其中有1例ALN阳性, 即假阴性)。99Tcm-硫胶体典型显像图见图 1。
99Tcm-硫胶体+亚甲蓝组51例中, 探测到SLN 51例, 20例SLN阳性(其中有1例仅SLN阳性); 31例SLN阴性(其中有1例为ALN阳性, 即假阴性)。2组对SLN的检出率、准确率、灵敏度、假阴性率、阴性预测值见表 1。
组别 检出率(%) 真阳性 假阴性 真阴性 准确率(%) 灵敏度(%) 假阴性率(%) 阴性预测值(%) 99Tcm-硫胶体 92.0 9 1 13 95.7 90.0 10.0 92.86 99Tcm-硫胶体+亚甲蓝组 100 20 1 30 98.0 95.2 4.8 986.77 表 1 单用99Tcm-硫胶体和99Tcm-硫胶体与亚甲蓝联合应用对早期乳腺癌SLN定位的比较
99Tcm-硫胶体及其联合染色法对早期乳腺癌前哨淋巴结探测的比较
Comparison of radioactive sulfur colloid and combined methylene blue injection methods for detection of sentinel lymph node in early breast cancer
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摘要:
目的 评价单用99Tcm-硫胶体和99Tcm-硫胶体与亚甲蓝联合应用探测早期乳腺癌前哨淋巴结(SLN)的效能。 方法 76例早期乳腺癌患者分为单用99Tcm-硫胶体组(25例)和99Tcm-硫胶体与亚甲蓝联合组(51例),分别在术前进行乳腺癌SLN探测,以腋窝淋巴结病理检查结果作为评价标准。 结果 76例患者中成功探测到SLN 74例,SLN的检出率、准确率、灵敏度和假阴性率在99Tcm-硫胶体组分别为92.0%、95.7%、90.0%、10.0%;在联合组分别为100%、98.0%、95.2%、4.8%。 结论 乳腺癌SLN探测可较准确预测腋窝淋巴结的转移状况,为外科医生确定手术方式提供重要信息,联合应用99Tcm-硫胶体和亚甲蓝可提高SLN的检出率和准确率,降低假阴性率。 -
关键词:
- 乳腺肿瘤 /
- 前哨淋巴结活组织检查 /
- 硫胶体 /
- 亚甲蓝
Abstract:Objective To compare the efficacy of 99Tcm-sulfur colloid and combined 99Tcm-sulfur colloid/methylene blue methods for detection of sentinel lymph node(SLN)in early breast cancer. Methods Seventy-six patients with early breast cancer were dived into two groups.In group 1(n=25), 99Tcm-sulfur colloid detection was used alone.In group 2(n=51), both 99Tcm-sulfur colloid detection and methylene blue methods were used.The pathological findings of resected axillary lymph nodes were regarded as evaluation standard. Results In 76 patients SLN was successfully detected in 74 cases.The SLN detection rate, accuracy, sensitivity and the false negative rate for 99Tcm-sulfur colloid group and combined group were 92.0%vs. 100%, 95.7%vs.98.0%, 90.0%vs.95.2%, and 10.0% vs.4.8% respectively. Conclusion SLN detection in early breast cancer may accurately predict axillary lymph node metastasis, thus providing important information for surgery.Combined use of 99Tcm-sulfur colloid and methylene blue methods may improve the SLN detection accuracy and reduce false negative rate. -
Key words:
- Breast neoplasms /
- Sentinel lymph node biopsy /
- Sulfur colloid /
- Methylene blue
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表 1 单用99Tcm-硫胶体和99Tcm-硫胶体与亚甲蓝联合应用对早期乳腺癌SLN定位的比较
组别 检出率(%) 真阳性 假阴性 真阴性 准确率(%) 灵敏度(%) 假阴性率(%) 阴性预测值(%) 99Tcm-硫胶体 92.0 9 1 13 95.7 90.0 10.0 92.86 99Tcm-硫胶体+亚甲蓝组 100 20 1 30 98.0 95.2 4.8 986.77 -
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