腋窝淋巴结状态是乳腺癌的分期、治疗方案的选择、以及预后的评估的重要依据,前哨淋巴结活检对于早期乳腺癌患者有重要的意义,是评估其是否转移的标准之一,是腋窝淋巴结阴性患者的标准术式。虽然前哨淋巴结具有创伤小,后遗症少等优点,...腋窝淋巴结状态是乳腺癌的分期、治疗方案的选择、以及预后的评估的重要依据,前哨淋巴结活检对于早期乳腺癌患者有重要的意义,是评估其是否转移的标准之一,是腋窝淋巴结阴性患者的标准术式。虽然前哨淋巴结具有创伤小,后遗症少等优点,可以很大程度地提高患者的生活质量,但是在传统观念上腋窝淋巴结清扫(ALND)仍然是前哨淋巴结阳性乳腺癌患者的标准治疗方法。近年来有研究表明,对于1~2个淋巴结微转移的患者可免除ALND,其总体生存并不会受到影响。对于腋窝淋巴结阳性患者新辅助治疗后能否行前哨淋巴结活检对腋窝淋巴结状态进行较为精准的评估仍然存在争议。本文将结合现有与前哨淋巴结活检相关文献,就前哨淋巴结活检的研究进展以及其在临床上面临的一些争议和问题做一综述。Axillary lymph node status is an important basis for the staging of breast cancer, the choice of treatment plan, and the evaluation of prognosis. Sentinel lymph node biopsy is of great significance for early breast cancer patients, and is one of the criteria for evaluating whether it is metastatic. It is also a standard operation for axillary lymph node negative patients. Although sentinel lymph nodes have the advantages of less trauma and fewer sequelae, which can greatly improve the quality of life of patients, in the traditional concept, axillary lymph node dissection (ALND) is still the standard treatment for patients with sentinel lymph node positive breast cancer. In recent years, studies have shown that patients with 1~2 lymph node micrometastases can be exempted from ALND, and their overall survival will not be affected. Whether sentinel lymph node biopsy can accurately evaluate axillary lymph node status in axillary lymph node positive patients after neoadjuvant therapy remains controversial. This article will review the research progress of sentinel lymph node biopsy and some controversies and problems in clinical practice based on the existing literatures related to sentinel lymph node biopsy.展开更多
目的:染料法是乳腺癌前哨淋巴结活检的方法之一,其成功率受多种因素影响。本研究旨在探讨影响染料法乳腺癌前哨淋巴结活检成功率的相关因素。方法:2007年1月—2008年8月乳腺癌患者141例,于乳晕周围注射1%亚甲蓝,实施前哨淋巴结活检,随...目的:染料法是乳腺癌前哨淋巴结活检的方法之一,其成功率受多种因素影响。本研究旨在探讨影响染料法乳腺癌前哨淋巴结活检成功率的相关因素。方法:2007年1月—2008年8月乳腺癌患者141例,于乳晕周围注射1%亚甲蓝,实施前哨淋巴结活检,随后行腋窝淋巴结清扫,常规HE染色进行病理诊断。采用非条件logistic回归进行单因素和多因素分析。结果:126例患者检出前哨淋巴结,15例检测失败。前哨淋巴结活检成功率89.4%,假阴性率为6.82%。单因素分析结果显示,活检成功率与患者年龄、体质量指数(body mass index,BMI)、肿瘤大小、术前腋窝淋巴结状态、肿瘤分级及腋窝淋巴结阳性数≥4枚显著相关。多因素分析结果显示,年龄(OR=4.587,P=0.024)、BMI(OR=4.882,P=0.011)及腋窝淋巴结阳性数≥4枚(OR=3.143,P=0.013)是前哨淋巴结活检成功率的独立影响因素。结论:亚甲蓝示踪法是乳腺癌前哨淋巴结活检的可靠方法,其成功率与患者年龄、BMI和腋窝淋巴结转移数相关。展开更多
文摘腋窝淋巴结状态是乳腺癌的分期、治疗方案的选择、以及预后的评估的重要依据,前哨淋巴结活检对于早期乳腺癌患者有重要的意义,是评估其是否转移的标准之一,是腋窝淋巴结阴性患者的标准术式。虽然前哨淋巴结具有创伤小,后遗症少等优点,可以很大程度地提高患者的生活质量,但是在传统观念上腋窝淋巴结清扫(ALND)仍然是前哨淋巴结阳性乳腺癌患者的标准治疗方法。近年来有研究表明,对于1~2个淋巴结微转移的患者可免除ALND,其总体生存并不会受到影响。对于腋窝淋巴结阳性患者新辅助治疗后能否行前哨淋巴结活检对腋窝淋巴结状态进行较为精准的评估仍然存在争议。本文将结合现有与前哨淋巴结活检相关文献,就前哨淋巴结活检的研究进展以及其在临床上面临的一些争议和问题做一综述。Axillary lymph node status is an important basis for the staging of breast cancer, the choice of treatment plan, and the evaluation of prognosis. Sentinel lymph node biopsy is of great significance for early breast cancer patients, and is one of the criteria for evaluating whether it is metastatic. It is also a standard operation for axillary lymph node negative patients. Although sentinel lymph nodes have the advantages of less trauma and fewer sequelae, which can greatly improve the quality of life of patients, in the traditional concept, axillary lymph node dissection (ALND) is still the standard treatment for patients with sentinel lymph node positive breast cancer. In recent years, studies have shown that patients with 1~2 lymph node micrometastases can be exempted from ALND, and their overall survival will not be affected. Whether sentinel lymph node biopsy can accurately evaluate axillary lymph node status in axillary lymph node positive patients after neoadjuvant therapy remains controversial. This article will review the research progress of sentinel lymph node biopsy and some controversies and problems in clinical practice based on the existing literatures related to sentinel lymph node biopsy.
文摘目的:染料法是乳腺癌前哨淋巴结活检的方法之一,其成功率受多种因素影响。本研究旨在探讨影响染料法乳腺癌前哨淋巴结活检成功率的相关因素。方法:2007年1月—2008年8月乳腺癌患者141例,于乳晕周围注射1%亚甲蓝,实施前哨淋巴结活检,随后行腋窝淋巴结清扫,常规HE染色进行病理诊断。采用非条件logistic回归进行单因素和多因素分析。结果:126例患者检出前哨淋巴结,15例检测失败。前哨淋巴结活检成功率89.4%,假阴性率为6.82%。单因素分析结果显示,活检成功率与患者年龄、体质量指数(body mass index,BMI)、肿瘤大小、术前腋窝淋巴结状态、肿瘤分级及腋窝淋巴结阳性数≥4枚显著相关。多因素分析结果显示,年龄(OR=4.587,P=0.024)、BMI(OR=4.882,P=0.011)及腋窝淋巴结阳性数≥4枚(OR=3.143,P=0.013)是前哨淋巴结活检成功率的独立影响因素。结论:亚甲蓝示踪法是乳腺癌前哨淋巴结活检的可靠方法,其成功率与患者年龄、BMI和腋窝淋巴结转移数相关。
