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目的:探讨乳癌哨兵淋巴结活检预测腋窝淋巴结转移状态的可靠性。方法:本组为2000年11月至2004年2月我院收治的140例乳癌患者。术中应用国产亚甲蓝注射液4~6 m l肿瘤上、外、下半圆形皮下连续注射,134例行乳癌改良根治术或患侧乳腺区段切除加腋窝淋巴结清扫术。术后解剖蓝染淋巴管,沿着色淋巴管找到蓝染的哨兵淋巴结。哨兵淋巴结及腋窝淋巴结常规行石蜡病理切片检查。5例行乳腺区段切除加哨兵淋巴结活检,1例行全乳切除加哨兵淋巴结活检(冰冻、石蜡病理检查SLN转移阴性),未行全腋窝淋巴结清扫。结果:140例患者中136例检出哨兵淋巴结,检出率97.14%,灵敏度88.71%,准确率94.31%,阴性预测值89.71%,假阴性率11.29%,仅哨兵淋巴结阳性7例。结论:应用亚甲蓝注射液淋巴结着色方法行乳癌哨兵淋巴结活检可以准确地预测腋窝淋巴结转移状态。
Objective: To explore the reliability of breast cancer sentinel lymph node biopsy to predict the status of axillary lymph node metastasis. Methods: This group consisted of 140 breast cancer patients admitted to our hospital from November 2000 to February 2004. Intraoperative application of domestic methylene blue injection 4 ~ 6 m l tumors, continuous subcutaneous injection of the upper and lower round, 134 cases of modified radical mastectomy or ipsilateral breast resection and axillary lymph node dissection. After the operation, the blue-stained lymphatic vessels were dissected and blue-stained sentinel lymph nodes were found along the lymphatic vessels. Sentinel lymph nodes and axillary lymph nodes routinely undergo paraffin pathological examination. Five patients underwent breast segmentectomy and sentinel lymph node biopsy. One patient underwent breast mastectomy and sentinel lymph node biopsy (frozen, paraffin-free pathological examination with SLN metastasis was negative). Complete axillary lymph node dissection was not performed. RESULTS: Sentinel lymph nodes were detected in 136 out of 140 patients. The detection rate was 97.14%, the sensitivity was 88.71%, the accuracy rate was 94.31%, the negative predictive value was 89.71%, the false negative rate was 11.29%, and only sentinel lymph nodes were positive in 7 cases. Conclusions: Breast cancer sentinel lymph node biopsy using methylene blue injection lymph node staining can accurately predict axillary lymph node metastasis.