美兰染色法在保乳术中前哨淋巴结活检定位的临床应用

目的探讨使用美兰染色法进行前哨淋巴结活检的可行性与准确性,为临床开展保乳保腋窝手术提供理论依据。方法 32例早期乳腺癌患者在切皮前10～15分钟在乳腺癌肿块周围四点法注射2%美蓝2 ml(总剂量),然后进行前哨淋巴结活检。于腋窝皱襞处沿皮纹做弧形切口,逐层切开,寻找到蓝染淋巴管后沿其追踪,直至找到蓝染淋巴结即为前哨淋巴结(Sentinel Lymph Node,SLN)。其通常位于胸大肌上端外侧缘。将所得SLN送术中冰冻及术后病理检查。然后进行常规的保乳手术及常规的腋窝淋巴结清扫(Ax-illary Lymph Node Dissection,ALND)。结果本研究成功检出SLN 31例,成功率96.8%。检出SLN个数2～4个不等,平均2.8个。术中快速冰冻病理SLN检查结果与术后ALN病理检查结果的比较,冰冻病理检查灵敏度91.7%(22/24);SLNB准确率90.3%(28/31);假阴性率8.2%(2/24);假阳性率4.1%(1/24)。术后病理,ALN检查与SLN检查结果比较,灵敏度95.8%(23/24);SLNB准确率93.5%(29/31);假阴性率4.1%(1/24);假阳性率4.1%(1/24)。比较:术中快速冰冻病理与术后病理检查SLN结果,术中快速冰冻病理SLN检查结果与术后ALN病理检查结果,术后病理ALN检查与SLN检查结果,均p>0.05,差异无统计学意义。结论本组31例患者采用美兰蓝色法定位前哨淋巴结,成功率达到96.8%。美蓝染色法能反应腋淋巴结转移状态,用于指导是否进一步腋窝淋巴结清扫有参考意义。为进一步缩小乳腺癌手术范围,开展保乳保腋窝手术提供了理论依据。

INVESTIGATING THE CLINICAL APPLICATION OF THE METHYLENE BLUE STAINING IN BREAST CONSERVATION SURGERY FOR LOCALIZING SENTINEL LYMPH NODE

Objective To explore the accuracy and feasibility of using methylene blue staining method for sentinel lymph node biopsy. Providing a theoretical basis for clinical application in breast conserving and avoiding ax- illary lymph node dissection. Methods 10 - 15 minutes before skin incision, we injected 2ml 2% methylene blue （ total dose） around four points of the tumor in 32 cases of early breast cancer patients, and then underwent sentinel lymph node biopsy. We made an arc incision along skin texture in the axillary folds, tracked along the blue - stained lymph tube until the blue- stained lymph node which was the sentinel lymph node （sentinel lymph node, SLN） was found. It is usually located in the upper lateral border of pectoralis major muscle. The SLN pathological examination was taken during and after operation. Then the conventional breast - conserving operation and conventional axillary lymph node dissection （ axillary lymph node dissection, ALND） were taken. Results 31 cases of SLN were success- fully detected, the success rate was 96.8%. 2 -4 SLNs were detected, average 2.8. comparising the results of fro- zen pathological examination intraoperation of SLN and the regular pathological examination postoperation of ALN, the frozen examination sensitivity was 91.7% （22/24） ; SLNB accuracy rate was 90.3% （28/31） ; the false negative rate was 8.2% （2/24） ; the false positive rate was 4.1% （1/24）. Comparising postoperative pathological examina- tion results of ALN and SLN, the sensitivity was 95.8% （23/24） ; SLNB accuracy rate was 93.5% （29/31） ; the false negative rate was 4.1% （1/24） ; the false positive rate was 4.1% （1/24）. Comparing the results of intraoper- ative and postoperative pathological examination of SLN, intraoperative frozen examination of SLN and postoperative examination of ALN, the postoperative pathological examination of ALN and SLN. all findings, P 〉 0. 05, the differ-ence was not statistically significant. Conclusion In this group of 31 patients by using methylene blue for localization of the sentinel lymph node, the success rate came to 96.8%. The state of axillary lymph node metastases can be ac- curaly reflected by using Methylene blue staining. This method can be used to guide whether axillary lymph node should be dissected or not and to provide theoretical basis for narrowing the operationscope of breast cancer and clini- cal application in breast conserving and avoiding axillary lymph node dissection.