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目的:探讨活体染料注射法识别乳腺癌患者哨兵淋巴结失败及假阴性的原因。方法:84例早期乳腺癌患者,在行乳腺癌根治术时先用活体染料亚甲蓝示踪剂作哨兵淋巴结活体组织检查(活检),切除哨兵淋巴结送冰冻切片检查,结果阴性者再用免疫组织化学法进一步检测。术后分离出全部乳腺及腋窝淋巴结送病理检查。结果及结论:本组病例中11例(13%)未找到哨兵淋巴结;在找到哨兵淋巴结的73例(87%)患者中,32例(44%)哨兵淋巴结受肿瘤累及,病理检查证实这些患者均有腋窝淋巴结转移,2例患者哨兵淋巴结未受肿瘤累及,但病理检查证实腋窝淋巴结有肿瘤转移,余39例哨兵淋巴结未受肿瘤累及,病理检查证实这些患者亦无腋窝淋巴结转移。哨兵淋巴结预测腋窝淋巴结状态的敏感性为94%,特异性100%,假阴性率3%。活体染料注射法识别哨兵淋巴结失败主要与手术者的技术熟练程度及采用方法欠妥有关,而假阴性的出现多为原发肿瘤过大及哨兵淋巴结位置变异所致。
OBJECTIVE: To investigate the causes of failure and false-negative of sentinel lymph node in breast cancer patients by in vivo dye injection. Methods: Eighty-four patients with early-stage breast cancer undergoing radical mastectomy were treated with live-dye methylene blue tracer for sentinel lymph node biopsy and resection of sentinel lymph nodes for frozen section examination. Negatives were re-immunized Histochemistry further test. After surgery, all the breast and axillary lymph nodes were removed for pathological examination. RESULTS AND CONCLUSION: Sentinel lymph nodes were not found in 11 patients (13%) in this group. Seventy-two (44%) sentinel lymph nodes were found in 73 (87%) patients who found sentinel lymph nodes. The pathological findings confirmed that these patients All had axillary lymph node metastases. Sentinel lymph nodes in 2 patients were not involved in the tumor. However, axillary lymph node metastases were confirmed by pathological examination. The remaining 39 sentinel lymph nodes were not involved in the tumor. Pathological examination confirmed that these patients had no axillary lymph node metastases. Sentinel lymph nodes predict axillary lymph node status with a sensitivity of 94%, specificity of 100%, and false-negative rate of 3%. In vivo dye injection method to identify sentinel lymph node failure is mainly related to the degree of technical proficiency and improper use of methods, and false negatives are mostly caused by excessive primary tumor and sentinel lymph node localization.