乳腺癌前哨淋巴结解剖学定位的临床研究

目的:探讨示踪剂注射部位对乳腺癌前哨淋巴结(sentinel lymph node,SLN)定位的影响。方法:对53例cN0期乳腺癌患者行核素示踪联合染料染色示踪法检测SLN,在原发肿瘤表面的皮下组织内或切除活组织检查残腔肿瘤周围两点注射99m锝(99mTc)标记的硫胶体,将卡纳琳或亚甲蓝分别注射于肿瘤对角线相应部位的皮下组织内(30例)或乳头乳晕下皮下组织内(23例)。SLN活组织检查后再行腋窝淋巴结清除术,标本行常规HE染色组织学检查。结果:53例患者均成功检测出SLN,核素示踪法与蓝染料法的成功率均为96.23%(51/53),联合检测的成功率100%(53/53),共检出SLN103枚,平均每例检出1.94枚,其中50例SLN位于胸大肌外侧缘的外侧组淋巴结(LevelⅠ),1例位于胸小肌后(LevelⅡ),1例同时位于LevelⅠ及LevelⅡ,1例同时位于LevelⅠ及胸骨旁。全部病例蓝染料与核素示踪标识的SLN均为同一枚(或同一组)淋巴结,两者完全吻合;且蓝染料注射于乳头乳晕或肿瘤对角线部位与核素注射于肿瘤周围所标识的SLN也完全一致。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,与示踪剂的注射部位无关。

Clinical research on the location of sentinel lymph node in primary breast cancer

Objective: To investigate the influence of tracer injection site on the location of sentinel lymph node in primary breast cancer patients. Methods: Sentinel lymph nodes biopsy was performed on 53 patients with cN0 breast cancer by combination using of 99mTc labeled sulfur colloid and blue dye. 99mTc labeled sulfur colloid was injected subcutaneously or into intraparenchymal tissue around primary tumor, whereas, methylene blue or Kanalin was injected in the diagonal quadrant region (30 cases) or sub-areola (23 cases). Axillary lymph node dissection was performed following sentinel lymph node biopsy. Results: The success rate of sentinel lymph node biopsy was 100% by combination method, and 96.23% by single isotope tracer or by single blue dye. The sentinel lymph nodes were both "hot" and blue in 49 patients. Conclusion: The identification of sentinel lymph nodes was independent of injection site of tracer. And it is suggested that sentinel lymph nodes were related to whole breast rather than the site of primary tumor.