前哨淋巴結手術在早期乳癌病人的應用與經驗

Experience with Sentinel Lymph Node Biopsy in Early Breast Cancer Patients at a Cancer Center

吳思萱(Shih-Hsuan Wu) ； 余本隆(Ben-Long Yu) ； 陳啟明(Chii-Ming Chen) ； 等

《台灣癌症醫學雜誌》 26卷1期 (2010/02) Pp. 21-27

https://doi.org/10.6323/JoCRP.2010.26.1.3

摘要

目的：本報告旨在描述和信治癌中心醫院將前哨淋巴結手術應用於乳癌的方法與結果。材料和方法：同時利用放射性同位素和甲基藍染料標定前哨淋巴結的位置。術前，由核子醫學科醫師進行放射性同位素前哨淋巴結攝影檢查。術中，由外科醫師進行甲基藍染料標定和取出前哨淋巴結，且在術中交由病理科醫師進行前哨淋巴結細胞學檢查，以決定是否需要進一步進行腋下淋巴廓清手術。結果：自2002年5月至2010年9月，扣除每一外科醫師在開始學習階段的個案後，計有2107例乳癌前哨淋巴結手術，偵測率為98.7%，偽陰性為2.1%，平均找到2.1顆前哨淋巴結；術中前哨淋巴結細胞學檢查的偽陰性為44.9%，因此有12.3%的病人需要進行第二次手術以完成腋下淋巴廓清；75.7%的病人無腋下淋巴轉移；取3顆前哨淋巴結有99.4%的機會可以正確地預測淋巴轉移，因此要正確預測評估腋下淋巴結狀態，取超過3顆前哨淋巴結，幫助十分有限。結論：前哨淋巴結手術為病人提供一新選擇，減少其不必要的傷害，這需要外科、核子醫學、病理檢驗、放射診斷等跨科部的密切團隊合作與監控每一個流程，才能確保手術成功與病人安全。

關鍵字

乳癌 ； 前哨淋巴結 ； 腋下淋巴廓清手術

並列摘要

Background: Sentinel lymph node biopsy (SLNB) is now widely used in patients with early- stage breast cancer with clinically negative axillary nodes. We hereby report our experience with SLNB at Koo Foundation Sun Yat-Sen Cancer Center.Methods: Both isotope and blue dye were used to identify sentinel lymph nodes in breast cancer patients with clinically negative axillary nodes. All patients underwent radionuclide lymphatic scan before surgery. SLNB was guided by gamma probe and blue dye. Intraoperative imprint cytology was used to evaluate sentinel lymph node status. Axillary lymph node dissection was performed when sentinel lymph nodes were positive.Results: From May 2002 to September 2010, 2107 SLNB procedures were performed after excluding each surgeon's learning cases. The identification rate was 98.7%. The SLNB false negative rate for surgeons was 2.1%. The average number of sentinel lymph nodes removed was 2.1. The false negative rate for imprint cytology was 44.9%, and 12.3% of cases may need a second operation to complete axillary lymph node dissection. In 75.7% of cases, there was no axillary lymph node metastasis, and 99.4% of node-positive cases had metastases in the first three sentinel lymph nodes. Removal of 3 sentinel lymph nodes was sufficient to predict the status of the remaining regional lymph nodes.Conclusions: Successful SLNB is dependent on a close collaboration among surgeons, nuclear medicine physicians, pathologists and radiologists. Strict quality control is also necessary.

並列關鍵字

breast cancer ； sentinel lymph node ； axillary lymph node dissection