中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
5期
1975-1979
,共5页
乳腺肿瘤%前哨淋巴结活组织检查%腋%超声检查
乳腺腫瘤%前哨淋巴結活組織檢查%腋%超聲檢查
유선종류%전초림파결활조직검사%액%초성검사
Breast neoplasm%Sentinel lymph node biopsy%Axilla%Ultrasonography
目的研究腋窝超声在临床检查腋淋巴结阴性的乳腺癌患者行前哨淋巴结活检（ SLNB ）中的应用价值。方法临床分期N0的乳腺癌患者116例蓝染料法下行SLNB，术前行腋窝超声检查，对最低位、最大和可疑阳性淋巴结进行体表标记，和术中前哨淋巴结位置及病理结果进行对照分析。另120例良性乳腺手术患者作为对照组。结果超声对腋淋巴结检出率乳腺癌组为84.48％（98/116），对照组为75.83％（91/120），两组间无统计学差异（ P＝0.105）。超声提示腋淋巴结阳性者36例，和病理结果对照，超声检查的灵敏度为80％，特异度90.12％，准确度为87.7％，阳性预测值77.78％，阴性预测值为91.25％。成功实施SLNB 110例，SLNB失败6例患者术前超声均未发现腋淋巴结。有82.75％（96/116）患者术中蓝染的前哨淋巴结位置和术前超声所见的腋淋巴结体表标记一致。结论大多数乳腺疾病患者都能在超声下发现腋窝淋巴结，乳腺癌患者腋窝超声能够在术前较准确判断腋淋巴结转移状况，并有助于定位前哨淋巴结，从而一定程度上减少单用蓝染料下前哨淋巴结活检术操作的盲目性，降低假阴性的发生。
目的研究腋窩超聲在臨床檢查腋淋巴結陰性的乳腺癌患者行前哨淋巴結活檢（ SLNB ）中的應用價值。方法臨床分期N0的乳腺癌患者116例藍染料法下行SLNB，術前行腋窩超聲檢查，對最低位、最大和可疑暘性淋巴結進行體錶標記，和術中前哨淋巴結位置及病理結果進行對照分析。另120例良性乳腺手術患者作為對照組。結果超聲對腋淋巴結檢齣率乳腺癌組為84.48％（98/116），對照組為75.83％（91/120），兩組間無統計學差異（ P＝0.105）。超聲提示腋淋巴結暘性者36例，和病理結果對照，超聲檢查的靈敏度為80％，特異度90.12％，準確度為87.7％，暘性預測值77.78％，陰性預測值為91.25％。成功實施SLNB 110例，SLNB失敗6例患者術前超聲均未髮現腋淋巴結。有82.75％（96/116）患者術中藍染的前哨淋巴結位置和術前超聲所見的腋淋巴結體錶標記一緻。結論大多數乳腺疾病患者都能在超聲下髮現腋窩淋巴結，乳腺癌患者腋窩超聲能夠在術前較準確判斷腋淋巴結轉移狀況，併有助于定位前哨淋巴結，從而一定程度上減少單用藍染料下前哨淋巴結活檢術操作的盲目性，降低假陰性的髮生。
목적연구액와초성재림상검사액림파결음성적유선암환자행전초림파결활검（ SLNB ）중적응용개치。방법림상분기N0적유선암환자116례람염료법하행SLNB，술전행액와초성검사，대최저위、최대화가의양성림파결진행체표표기，화술중전초림파결위치급병리결과진행대조분석。령120례량성유선수술환자작위대조조。결과초성대액림파결검출솔유선암조위84.48％（98/116），대조조위75.83％（91/120），량조간무통계학차이（ P＝0.105）。초성제시액림파결양성자36례，화병리결과대조，초성검사적령민도위80％，특이도90.12％，준학도위87.7％，양성예측치77.78％，음성예측치위91.25％。성공실시SLNB 110례，SLNB실패6례환자술전초성균미발현액림파결。유82.75％（96/116）환자술중람염적전초림파결위치화술전초성소견적액림파결체표표기일치。결론대다수유선질병환자도능재초성하발현액와림파결，유선암환자액와초성능구재술전교준학판단액림파결전이상황，병유조우정위전초림파결，종이일정정도상감소단용람염료하전초림파결활검술조작적맹목성，강저가음성적발생。
Objective To evaluate the usefulness of axillary ultrasound ( US) in preoperatively identifying sentinel lymph node in breast cancer patients with no palpable axillary lymph nodes .Methods A total of 116 clinically N0 breast cancer patients had sentinel lymph node biopsy ( SLNB ) performed solely with blue dye technique .They underwent axillary US examination preoperatively using Philip Envisor 2540-A gray scale and color Doppler US with high-resolution linear transducer (12-16 MHz).The positions of the lowest or the largest or most suspicious node were marked on the skin if detected in the axillae on US .The status of these lymph nodes were identified to the final location and pathology results of SLN .120 patients with benigh breast disease also underwent axillary US examination as compared group .Results Axillary lymph nodes can be detected in 84.48%(98/116) breast cancer patients .According to the finding of US examination ,124 marks were made on the skin of the patients . 75.83%(91/120)patients of benigh breast disease had visible axillary lymph node on US (P=0.105).Abnormal lymph nodes were presented in 36 breast cancer patients.Correlated with the final pathology results ,the sensitivity, specificity,accuracy ,positive predictive value and negative predictive value of axillary US in the diagnosis of nodal metastasis were 80%,90.12%,87.7%,77.78% and 91.25%,respectively.SLNB were performed successfully in 110 patients,while 6 patients who failed in SLNB had no axillary node visible on US .96 patients(82.75%,96/116) had blue dye staining SLN in the location corresponded to the point of sonographic node preoperatively . Conclusions Most patients have visible axillary node on US .Axillary US can diagnose lymph node metastases and may be clinically useful to identify the probable location of the sentinel lymph node ,which help surgeons to facilitate a more rapid harvest and reduce false negtive result in SLNB .
