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目的通过研究前哨淋巴通道(SLCs)及其与前哨淋巴结(SLN)之间的解剖关系,探讨乳腺癌前哨淋巴结活检(SLNB)出现假阴性的机制。方法62例乳腺癌患者术前作外侧角即θe标记。全身麻醉后于乳晕内侧缘注入美蓝3ml。取改良根治术标本仔细解剖连接乳晕和SLN之间的SLCs,观察其走行方向、走行途径、数量及与SLN之间的关系。结果52例(83·9%)成功解剖SLCs及其连接的SLN,其中49例(94·2%)SLCs的θe角为31°~90°,36例(69·2%)θe角为61°~90°。1枚SLN者48例(92·3%),2枚者4例(7·7%)。SLCs与SLN有3种连接方式:2条独立的SLCs各连接1枚SLN;1条SLCs进入腋窝前后分成若干分支连接1枚SLN;1条SLCs进入腋窝前分成2条各连接1枚SLN,且2枚SLN可位于腋窝的不同群。沿SLCs解剖出的SLN,病理结果未发现有假阴性和假阳性。结论尚未发现乳腺癌腋窝“跳跃式”淋巴转移模式,推测SLNB假阴性的产生是技术问题,可能与手术者对SLCs和SLN行走路线和数量的复杂性认识不足有直接关系。
Objective To investigate the mechanism of false negatives in sentinel lymph node biopsy (SLNB) in breast cancer by studying the relationship between sentinel lymph nodes (SLCs) and the sentinel lymph nodes (SLN). Methods 62 cases of breast cancer patients preoperative lateral angle θe mark. After systemic anesthesia in the medial margin of the areola into methylene blue 3ml. The specimens of modified radical mastectomy were carefully dissected and the SLCs between the areola and the SLN were carefully dissected to observe the direction of the SLCs, the pathways, the number of SLNs and the relationship with SLN. Results 52 cases (83.9%) successfully dissected the SLCs and their connected SLNs. Among them, 49 cases (94.2%) had θe angles between 31 ° and 90 ° and 36 cases (69.2%) had θe angles of 61 ° ~ 90 °. One patient had SLN in 48 cases (92.3%) and two patients in 4 patients (7.7%). There are 3 kinds of connection between SLCs and SLN: 2 independent SLCs each connect 1 SLN; 1 SLCs is divided into several branches before and after entering the armpit to connect 1 SLN; 1 SLCs is divided into 2 connected SLNs Two SLNs can be located in different groups of the axilla. SLNs dissected along the SLCs showed no false-negative or false-positive results. Conclusions The “leaping” lymphatic metastasis model of axillary lymph nodes in breast cancer has not been found yet. It is speculated that the occurrence of false negative SLNB is a technical problem, which may be directly related to the lack of understanding of the complexity of SLCs and SLN walking routes and numbers.