早期乳腺癌非前哨淋巴结阴性者避免腋窝清扫的临床研究

发布时间：2018-01-04 03:05

本文关键词：早期乳腺癌非前哨淋巴结阴性者避免腋窝清扫的临床研究　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的分析比较早期乳腺癌前哨淋巴结(Sentinel Lymph Node,SLN)微转移时非前哨淋巴结(Non sentinel lymph node,NSLN.)的转移状况,探讨SLN发生微转移时以前哨淋巴结活检(Sentinel Lymph Node Biopsy,SLNB)替代腋窝淋巴结清扫(Axillary lymph node dissection,ALND)的安全性、可行性。方法对早期乳腺癌(T1-2N0M0)患者,术中用亚甲蓝染色法寻找前哨淋巴结,所有检出的前哨淋巴结送快速冰冻病理并常规病理检查。本研究分两个阶段进行。第一阶段:无论SLN阴性、微转移还是宏转移一律作全乳房切除或保留乳房+ALND;第二阶段:SLN阴性者同意不作ALND做全乳房切除或保留乳房+SLNB,SLN微转移及宏转移者则作全乳房切除或保留乳房+ALND。术后常规辅助化疗、放疗、内分泌治疗、分子靶向治疗。保乳手术常规残乳放疗,未作ALND者不常规照射腋窝。统计分析资料,探讨SLN微转移患者以SLNB代替ALND的安全性、可行性,比较SLNB与ALND的术后并发症的发生情况。结果1、本组SLN 202的检出率为93.1%,其中第一阶段的检出率为91.9%,第二阶段的检出率为94.2%;2、本组的假阴性率为3.23%;3、第一阶段与第二阶段之间患者的年龄、肿瘤分期、肿瘤所在位置、病理类型及组织学分级没有明显差异(P0.05);4、第一阶段与第二阶段检出的SLN在个数及对应的病例数上没有统计学差异(P0.05)。5、第一阶段与第二阶段所检出的SLN有微转移或宏转移在病例数和转移数目上无统计学差异(P0.05)。6、在SLN阴性与SLN微转移病例中,NSLN均未发生宏转移,发生微转移几率没有统计学差异(P0.05);7、SLN的转移数/检出数比值越小,NSLN发生转移的风险越低,差异具有统计意义(P0.05);在检出的SLN≥3个,而仅有1枚SLN发生宏转移时NSLN均未发生微转移及宏转移;8、SLNB组与腋窝清扫相关的并发症(如上肢淋巴水肿、腋区疼痛、上肢麻木以及上肢运动受限等)明显低于ALND组。结论1、前哨淋巴结微转移状况下非前哨淋巴结未发生宏转移,而发生微转移的几率与前哨淋巴结阴性时非前哨淋巴结发生微转移的几率没有统计学差异(P0.05),证明前哨淋巴结微转时可以不作腋窝淋巴结的清扫,即:SLNB可以替代ALND;2、前哨淋巴结的转移数/检出数比值越小,非前哨淋巴结发生转移风险越低,差异具有统计学意义(P0.05);当前哨淋巴结≥3个而其中仅有1枚发生宏转移时,非前哨淋巴结均未发生转移,也可能这种情况下可以不作腋窝淋巴结的清扫。由于本组样本量小,尚不能作出肯定的结论。我们将会继续这方面的临床研究。另外,在作前哨淋巴结活检时应尽可能耐心、细致地多寻找蓝管,多检出前哨淋巴结;3、在前哨淋巴结发生微转移时,以前哨淋巴结活检替代腋窝淋巴结清扫可以进一步降低手术并发症。
[Abstract]:Objective to compare the sentinel Lymph Node of early breast cancer. The metastatic status of non sentinel lymph nodeus in non sentinel lymph nodes with SLN micrometastasis. To investigate the sentinel Lymph Node Biopsy (Sentinel Lymph Node Biopsy) in micrometastasis of SLN. The safety of axillary lymph node dissection for axillary lymph node dissection (SLNBs). Methods: the sentinel lymph nodes were searched by methylene blue staining in patients with early breast cancer (T1-2N0M0). All sentinel lymph nodes detected were rapidly frozen with routine pathological examination. This study was conducted in two stages. The first stage: SLN negative. Micrometastases or macro metastases were performed with total mastectomy or breast ALND preservation. Stage 2: SLN-negative patients agreed not to do ALND for total mastectomy or to preserve breast SLNB. SLN micrometastases and macrometastases were performed with total mastectomy or breast preservation. Routine adjuvant chemotherapy, radiotherapy, endocrine therapy, molecular targeted therapy, breast conserving surgery and conventional residual breast radiotherapy were performed. Patients without ALND were exposed to axilla unroutinely. Statistical analysis was made to explore the safety and feasibility of replacing ALND with SLNB in patients with micrometastasis of SLN. Results 1 the detection rate of SLN 202 in this group was 93. 1 and the detection rate in the first stage was 91.9%. The detection rate of the second stage was 94.2; 2, the false negative rate of this group is 3.23; 3There was no significant difference in age, tumor stage, location of tumor, pathological type and histological grade between the first stage and the second stage (P 0.05). 4, there was no statistical difference in the number of SLN detected in the first stage and the second stage and the corresponding number of cases (P 0.05). The SLN detected in the first stage and the second stage had micrometastasis or macro metastasis. There was no significant difference in the number of cases and the number of metastases (P0.05. 6). In SLN negative cases and SLN micrometastasis cases. There was no macro metastasis in NSLN, and there was no significant difference in the probability of micrometastasis (P 0.05). The smaller the ratio of transfer number to detection number of SLN is, the lower the risk of NSLN metastasis is. The difference is statistically significant (P 0.05). No micrometastasis or macro metastasis occurred in NSLN when only one SLN had macro metastasis and the detected SLN was more than 3. The complications associated with axillary dissection (such as upper limb lymphedema, axillary pain, upper limb numbness and upper limb motor limitation) were significantly lower in the ALND group than in the ALND group. Conclusion 1. There was no macro metastasis in non-sentinel lymph nodes under the condition of sentinel lymph node micrometastasis. However, there was no statistical difference in the probability of micrometastasis between sentinel lymph nodes and non-sentinel lymph nodes when the sentinel lymph nodes were negative. It was proved that the axillary lymph nodes could not be dissected when the sentinel lymph nodes turned slightly. That is,: SLNB can replace ALND; 2, the smaller the ratio of the number of sentinel lymph node metastasis to the number of detection, the lower the risk of metastasis of non-sentinel lymph node, the difference is statistically significant (P 0.05); When there were more than 3 sentinel lymph nodes and only one of them had macro metastasis, none of the non-sentinel lymph nodes had metastases. In this case, the axillary lymph nodes could not be dissected. We will continue our clinical research in this field. In addition, we should be as patient as possible in performing sentinel lymph node biopsy, look for more blue tubes and detect more sentinel lymph nodes. 3. In the case of sentinel lymph node micrometastasis, the replacement of axillary lymph node dissection with sentinel lymph node biopsy can further reduce the surgical complications.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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