【作者】 赵胜雷；

【导师】 刘剑仑；

【作者基本信息】 广西医科大学 ， 肿瘤学， 2010， 硕士

【摘要】 目的:研究前哨淋巴结活检术(SLNB)在乳腺癌中的最佳定位方法及其临床应用的意义。方法:采用美兰染色及美兰联合核素淋巴显像的方法对132例早期乳腺癌患者(其中美兰法50例,联合法82例)行前哨淋巴结活检术(SLNB)。分析两种示踪方法对前哨淋巴结(SLN)识别的检出率及其影响因素。对3例SLN病理阴性而腋窝淋巴结病理阳性患者的SLN再次多层连续切片和免疫组织化学(CK-19)病理检查。结果:1、132例患者行前哨淋巴结活检术,成功检出115例,检出率87.1%,总共检出前哨淋巴结245枚,其中1枚者38人、2枚者57人、3枚者15人、4枚者5人,平均2.1枚。2、美兰组、联合组SLN的识别成功率分别为78.0%、92.7%;准确率分别为94.9%、98.7% ;假阴性率为22.2%、4.5%;美兰组与联合组在SLN的识别成功率上存在显著性差异(P<0.05)。3、两种方法SLN识别成功率与原发肿瘤的大小、肿瘤所在的象限、病理类型无关(P>0.05),与学习曲线、患者的年龄显著相关(P<0.05)。结论:(1)联合组较美兰组有更高的SLN识别成功率;(2)经过学习曲线后和对较年轻的患者,SLN识别成功率增加;(3)SLN可预测乳腺癌腋窝淋巴结转移状况;(4)SLN在早期乳腺癌患者可替代常规ALND。更多还原

【Abstract】 Objectives: To research the method of lymphatic mapping and the meaning of the clinical study of sentinel lymph node biopsy in the patients with breast cancer.Methods: To analize the identification of sentinel lymph node and the influential factors, the one hundred and thirty-two patients with breast cancer were carried out sentinel lymph node biopsy using either methylene blue or 99mTc-DX and methylene blue. The sentinel lymph nodes that were negative firstly while axillary lymph nodes were positive were stained with the multilap continuous slice and immunohistochemical by monoclonal antibody CK-19 . Then modified radical mastectomy and simple breast surgery be carried out.Results: 1. There are 132 cases of patients with sentinel lymph node biopsy, 115 cases of successful detection.The detection rate is 87.1%, a total of 245 sentinel lymph nodes were detected, of which one in 38 people, two in 57 people, three in 15 people, 4 in 5, mean is 2.1. 2、SLN succeed rates were 78.0% and 92.7%,respectively. The accuracy rates of SLN were 94.9% and 98.7% . the false negative were 22.2% and 4.5% in the two groups ,respectively.There are obviously difference between blue dye group and the combination group about success rates(P<0.05).2、The success rate of SLN is irrelevate with the size of primary tumour, tumor location, clinic pathologic types(P>0.05),while the study curve and the age of patients were independent factors significantly correlated with the success rate of SLN in our study (P<0.05).Conclusions: 1.The success rate of SLN in combination group is obviously higher than blue dye group. 2.After the study curve and among the younger patients the identification rate was higher. 3.SLN maybe can predict the axillary lymph node status of the early stage breast cancer. 4. ALND would be replaced by SLN among the patients whose SLN(s) have not tumor metastasis in their early stage breast cancer.更多还原