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目的 探讨不同方法检测乳腺癌前哨淋巴结 (sentinellymphnode,SLN)的可行性及其临床意义。 方法 71例经细针穿刺或术中冰冻切片诊断为乳腺癌而临床无腋窝淋巴结肿大的女性患者 ,随机分为 4组 ,其中亚甲蓝淋巴示踪 2 4例 ,活性染料异硫蓝示踪 2 9例 ,核素99m锝 硫胶体示踪 8例 ,染料与核素联合示踪 10例 ,确认并切除前哨淋巴结 ,将其单独送病理 ,随后行乳腺癌手术 ,包括传统的腋窝淋巴结清扫术。 结果 71例患者中有 6 0例成功确定前哨淋巴结 ,检出率 84 5 % ,其中亚甲蓝组 75 0 % (18/ 2 4 ) ,异硫蓝组 86 2 % (2 5 / 2 9) ,核素组检出 7例 ,联合组全部检出 ;该技术总的敏感性 83 3% ,4组分别为 70 0 %、90 0 %、10 0 %、10 0 % ;假阴性率各组分别为 30 0 %、10 0 %、0、0 ;总的准确率 93 3% ,各组分别为 83 3%、96 0 %、10 0 %、10 0 %。各组寻找前哨淋巴结平均花费时间分别为2 9、2 2、7、6min。 结论 前哨淋巴结活检技术在临床是可行的 ,绝大多数前哨淋巴结可以比较准确地反映其余腋窝淋巴结的组织学特点。活性染料与核素联合示踪既直观又准确 ,是最佳的选择方法。
Objective To investigate the feasibility and clinical significance of different methods for the detection of sentinellymphnode (SLN) in breast cancer. Methods A total of 71 women with breast cancer who were diagnosed as breast cancer by intra-operative needle biopsy or intraoperative frozen section were randomly divided into 4 groups. Among them, 24 cases were detected by methylene blue staining and isosulfan Tracer 29 cases, 99m Tc sulfur colloper trace 8 cases, dye and radionuclide combined tracing 10 cases, confirmed and removed sentinel lymph node, the pathology alone, followed by breast cancer surgery, including the traditional axillary lymph node dissection Surgery. Results Sixty of 71 patients were confirmed to have sentinel lymph nodes with a detection rate of 84.5%, among which 75.0% (18/2 4) in methylene blue group and 86.2% (25/29) in isosulfan group , 7 cases of radionuclide group were detected, the combination group were all detected; the overall sensitivity of the technology was 83.3%, 70%, 90%, 100%, 100% respectively; the false negative rate of each group Respectively 30 0%, 100%, 0,0; the overall accuracy 93 3%, respectively 83 3%, 96 0%, 100%, 100% in each group. The average time spent looking for sentinel lymph nodes in each group was 29, 29, 27, 6 min. Conclusions Sentinel lymph node biopsy is feasible in clinical practice. The vast majority of sentinel lymph nodes can accurately reflect the histological features of the remaining axillary lymph nodes. The combination of reactive dye and nuclide tracking is both intuitive and accurate and is the best choice.