CAJ | 학술논문

目的探讨99mTc-硫胶体(99mTc-SC)淋巴结显像联合亚甲蓝行乳腺癌前哨淋巴结活检(SLNB),对前哨淋巴结(SLN)阴性者避免行腋窝淋巴结清扫(ALND)的可行性及其临床应用价值.方法 187例乳腺癌患者术前行99mTc-SC淋巴结显像,并进行体表定位,术中加用亚甲蓝示踪SLN,切除后快速冰冻切片.其中51例SLN转移患者行改良根治术,将136例SLN阴性患者分为两组,A组[为腋窝淋巴结阳性患者,58例为术中检测阳性,2例为SLNB术后淋巴结常规病理检查阳性,再次行ALND,共60例]行乳腺切除或象限切除加ALND,B组(术中检测阴性78例,除去术后检测阳性2例,共76例)行SLNB,未行ALND.结果 A组术后上肢麻木、上肢水肿、上肢功能障碍分别为36、8、45例,B组分别为2、0、0例,两组比较差异有统计学意义(P<0.05).A组1、3、5年局部复发分别为0、0、2例,腋窝及锁骨上淋巴结转移分别为1、5、8例,远处转移分别为2、8、12例,无瘤生存分别为60、57、49例;B组1、3、5年局部复发分别为0、0、6例,腋窝及锁骨上淋巴结转移分别为3、8、12例,远处转移分别为4、8、16例,无瘤生存分别为76、70、61例,两组比较差异无统计学意义(P>0.05).结论 99mTc-SC淋巴结显像联合亚甲蓝行SLNB方法简便,准确率高,疗效确实可靠.
목적 탐토99mTc-류효체(99mTc-SC)림파결현상연합아갑람행유선암전초림파결활검(SLNB),대전초림파결(SLN)음성자피면행액와림파결청소(ALND)적가행성급기림상응용개치.방법 187례유선암환자술전행99mTc-SC림파결현상,병진행체표정위,술중가용아갑람시종SLN,절제후쾌속빙동절편.기중51례SLN전이환자행개량근치술,장136례SLN음성환자분위량조,A조[위액와림파결양성환자,58례위술중검측양성,2례위SLNB술후림파결상규병리검사양성,재차행ALND,공60례]행유선절제혹상한절제가ALND,B조(술중검측음성78례,제거술후검측양성2례,공76례)행SLNB,미행ALND.결과 A조술후상지마목、상지수종、상지공능장애분별위36、8、45례,B조분별위2、0、0례,량조비교차이유통계학의의(P<0.05).A조1、3、5년국부복발분별위0、0、2례,액와급쇄골상림파결전이분별위1、5、8례,원처전이분별위2、8、12례,무류생존분별위60、57、49례;B조1、3、5년국부복발분별위0、0、6례,액와급쇄골상림파결전이분별위3、8、12례,원처전이분별위4、8、16례,무류생존분별위76、70、61례,량조비교차이무통계학의의(P>0.05).결론 99mTc-SC림파결현상연합아갑람행SLNB방법 간편,준학솔고,료효학실가고.
Objective To evaluate the clinical significance of the axillary conservative surgery by sentinel lymph node biopsy (SLNB) using preoperative lymphoscintigraph technique with 99mTc-SC and methylene blue in early-stage breast cancer patients. Methods The sentinel lymph node (SLN) of 187 patients were located with preoperative lymphoscintigraph technique with 99mTc-SC and labeled with methylene blue during the operations. The metastasis of SLN was detected using frozen section technique. There were 51 patients whose SLN were positive having been carried with modified radical mastectomy of breast cancer and axillary lymph node dissection (ALND), 136 patients' SLN were negative,58 patients of those were carried with mammectomy or partial mastcctomy and ALND (group A),while 78 patients were carried out with mammectomy or partial mastectomy only (group B). The sentinel lymph nodes were detected with HE stain after surgery. All the patients were treated with chemotherapy,and the patients with partial mastcctomy must be treated with radiotherapy. There were 2 patients with micrometastasis in group B being treated with mammectomy or partial mastcctomy only,and carried out with ALND again. Results The number of cases with upper limb numbness, edema, dysfunction in group A were 36,8 and 45 cases, in group B were 2,0,0 case respectively. Group A compared with group B was increased significantly (P< 0.05). The number of local recurrence within 1, 3 and 5 years were 0,0,2 cases;lymphatic metastasis were 1,5,8 cases; the distant metastasis were 2,8,12 cases; the disease-free survival were 60,57,49 cases. In group B, the number of local recurrence within 1, 3 and 5 years were 0,0,6 cases, lymphatic metastasis were 3,8,12cases,the distant metastasis were 4,8,16 cases,the disease-free survival were 76,70,61 cases. There were not significant differences between the two groups(P> 0.05). Conclusion It is simple and accurate to carry out SLNB using preoperative lymphoscintigraph technique with 99mTc-SC combined with methylene blue,and the effect is reliable.