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目的:探讨乳腺癌腔镜下腋窝前哨淋巴结活检术(ESLNB)的临床可行性。方法:选取2010年3月—2012年6月我院收治住院的45例早期乳腺癌患者。首先行ESLNB,所获前哨淋巴结送术中快速病理和术后病理检查,然后行腋窝淋巴结清扫术(ALND),所获淋巴结送术后病理检查。评价ESLNB的灵敏度、准确率、假阴性率和假阳性率。将ESLNB与ALND对腋窝淋巴结转移情况的评估结果进行对比。结果:成功检出前哨淋巴结43例,成功率为95.6%。ESLNB术中快速病理检查的灵敏度为90.1%,准确率为88.4%,假阴性率9.1%,假阳性率6.06%;ESLNB术后病理检查的灵敏度为93.9%,准确率为90.1%,假阴性率6.06%,假阳性率6.06%。ESLNB术中快速及术后病理检查与ALND术后病理检查对腋窝淋巴结转移状况的评估结果比较,无统计学差异(P>0.05)。结论:亚甲蓝染色法行乳腺癌腔镜下腋窝前哨淋巴结活检术安全可行,为缩小乳腺癌的手术范围开辟了新的途径。
Objective: To investigate the clinical feasibility of endoscopic axillary lymph node biopsy (ESLNB) under endoscopy in breast cancer. Methods: Forty-five patients with early-stage breast cancer admitted to our hospital from March 2010 to June 2012 were selected. The first line of ESLNB, sent sentinel lymph node surgery in rapid pathology and postoperative pathological examination, and then line axillary lymph node dissection (ALND), obtained lymph node biopsy pathology. The sensitivity, accuracy, false negative rate and false positive rate of ESLNB were evaluated. The results of ESLNB and ALND assessment of axillary lymph node metastasis were compared. Results: Sentinel lymph nodes were successfully detected in 43 cases with a success rate of 95.6%. The sensitivity of ESLNB was 90.1%, the accuracy rate was 88.4%, the false negative rate was 9.1% and the false positive rate was 6.06%. The sensitivity of postoperative pathological examination of ESLNB was 93.9% and the accuracy was 90.1% 6.06%, false positive rate 6.06%. There was no significant difference (P> 0.05) between ESLNB intraoperative rapid and postoperative pathological examination and ALND postoperative pathological examination in assessing axillary lymph node metastasis. Conclusion: Methylene blue staining is an effective and safe method for endoscopic lymph node biopsy of axillary lymph nodes in breast cancer. It opens a new way for reducing the surgical scope of breast cancer.