Nandu Vipul V, Chaudhari Milind S
Department of General Surgery, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra India.
Indian J Surg Oncol. 2017 Jun;8(2):109-112. doi: 10.1007/s13193-016-0616-z. Epub 2016 Dec 28.
Breast cancer is the leading malignancy and the second leading cause of cancer-related deaths. Axillary lymph node status is a very important prognostic factor in breast cancer patients; nodal evaluation is therefore a critical part of breast cancer management. Axillary lymph node dissection results in significant morbidity. Sentinel lymph node biopsy (SLNB) is being used in many centers to stage the axilla in planning axillary dissection management of patients and hence plays an important part in reducing morbidity among patients with carcinoma breast. The objectives of this paper is to study the (1) efficacy of sentinel lymph node biopsy in detecting axillary metastasis, (2) location of sentinel lymph node in the axilla, (3) rate of involvement of sentinel lymph nodes, and (4) incidence of skip metastasis. Thirty-five patients with breast cancer with clinically node-negative axilla were selected for the study. Methylene blue dye was injected intralesional and perilesional 20 min prior to surgery. All patients underwent modified radical mastectomy with sentinel lymph node biopsy and axillary dissection and after pathological examination diagnostic statics, namely sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were computed. Sentinel lymph node was identified in all of these patients. Sixty percent patients had pathologically positive lymph nodes in the axilla. 90.48% patients of these had sentinel lymph nodes positive for malignant cells. Incidence of skip metastasis is 9.52%. 88.57% patients had sentinel lymph node mapped to level I lymph nodes. Sensitivity of SLNB is 90.48%, specificity is 85.71%, PPV of is 90.48%, NPV is 85.71%, and accuracy is 88.57%. Sentinel lymph node biopsy is an effective method of staging the axilla and deciding on axillary clearance in patients of carcinoma breast. Unnecessary axillary dissection and associated complications can be prevented in most of patients due to sentinel lymph node biopsy.
乳腺癌是最主要的恶性肿瘤，也是癌症相关死亡的第二大原因。腋窝淋巴结状态是乳腺癌患者非常重要的预后因素；因此，淋巴结评估是乳腺癌治疗的关键部分。腋窝淋巴结清扫会导致明显的发病率。前哨淋巴结活检（SLNB）正在许多中心用于对腋窝进行分期，以规划患者腋窝清扫的治疗方案，因此在降低乳腺癌患者的发病率方面发挥着重要作用。本文的目的是研究（1）前哨淋巴结活检在检测腋窝转移方面的有效性，（2）前哨淋巴结在腋窝中的位置，（3）前哨淋巴结的受累率，以及（4）跳跃转移的发生率。选择35例临床腋窝淋巴结阴性的乳腺癌患者进行研究。术前20分钟在瘤内和瘤周注射亚甲蓝染料。所有患者均接受改良根治性乳房切除术加前哨淋巴结活检和腋窝清扫，术后经病理检查计算诊断统计学指标，即敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。所有这些患者均识别出前哨淋巴结。60%的患者腋窝淋巴结病理检查呈阳性。其中90.48%的患者前哨淋巴结有恶性细胞阳性。跳跃转移的发生率为9.52%。88.57%的患者前哨淋巴结定位于I级淋巴结。SLNB的敏感性为90.48%，特异性为85.71%，PPV为90.48%，NPV为85.71%，准确性为88.57%。前哨淋巴结活检是对乳腺癌患者腋窝进行分期和决定腋窝清扫的有效方法。由于前哨淋巴结活检，大多数患者可以避免不必要的腋窝清扫及相关并发症。
