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目的:研究术前核素扫描淋巴显相和术中蓝色染料定位活检乳腺癌前哨淋巴结(SLN)的临床应用价值。方法:68例病理诊断乳腺癌,临床腋窝淋巴结阴性患者,术前核素99Tcm-标记硫胶体(99Tcm-sulfur colloid)乳腺区域淋巴系统扫描显相,术中亚甲蓝染色定位活检前哨淋巴结,切除的SLN与清除区域淋巴结送常规病理检查。结果:乳腺癌SLN核素淋巴显相检出率为94.1%(64/68),手术通过蓝色染料定位检出率为91.2%(62/68)。假阴性率9.4%(3/32),SLN预测腋窝转移的准确率为96.8%(58/68),敏感性90.6%(29/32),特异性100.0%(32/32)。结论:淋巴显相结合蓝色染料法,能准确显示SLN的部位、数目及淋巴引流渠道,术前常规淋巴显像造影可增加前哨淋巴结的预知性,有助于指导内乳区及腋窝外其他淋巴结的放疗决策。
Objective: To study the clinical value of preoperative nuclide scanning lymphography and intraoperative blue dye localization biopsy of sentinel lymph node (SLN) in breast cancer. Methods: Sixty-eight patients with pathologically diagnosed breast cancer and clinical negative axillary lymph nodes were examined with 99Tcm-sulfur colloid lymph node system. The lymph nodes were excised with methylene blue staining and biopsy. SLN and regional lymph node dissection to send routine pathological examination. Results: The detection rate of SLN nuclide lymphadenectomy in breast cancer was 94.1% (64/68). The detection rate of blue dye in operation was 91.2% (62/68). The false negative rate was 9.4% (3/32). The accuracy of SLN in axillary metastasis was 96.8% (58/68), the sensitivity was 90.6% (29/32) and the specificity was 100.0% (32/32). CONCLUSION: Lymphadenectomy combined with blue dye method can accurately display the location and number of SLNs and lymphatic drainage channels. Preoperative routine lymphadenectomy can increase the predictability of sentinel lymph nodes and help to guide the internal mammary region and axillary Lymph node radiotherapy decisions.