To Explore The Influential Factors Of Sentinel Lymph Node Biopsy With Living Dyes In The Patients With Breast Cancer

Background and objectBreast cancer is one of common malignant tumor in women, it severely endanger women's health. There are about 1,200,000 women were diagnosed as breast cancer ,and 500,000women died of this disease every year over the world. The incidence of breast cancer is rising in recent years in our country. The datas displayed by China Cancer Research Foundation(CCRF) show that breast cancer has been the highest incidence of women's malignant tumor in cities as ShangHai, BeiJing, Guang Zhou and so on. The state of axillary nodes is one of the key factors for prognosis. The axillary lymph nodes dissection (ALND) is the major component of treatment for breast cancer always, and it means significance for clinical stage, judgement of prognosis, directing for the postoperative treatment and prevention for local recurrence. As the percentage of early breast cancer diagnosed is higher, the negative axillary nodes are more and more. For these patients, the ALND can't upgrade the survival after operation, and its complications—edema of the upper extremity, dyscinesia, fluidify of axillary fossa, infection, necrosis of flap, acroanesthesia and so on , causes a lot of distress. The sentinel lymph node(SLN) is the first lymph node of lymph fluid draining for the primartumor, and then metastasizes to distal lymph nodes. If the SLN(s) have no tumor metastasis, there is no metastasis primartumor in another lymph node in abstracto. The sentinel lymph node biopsy(SLNB) is the significance progress in breast surgery in the 1990s.The significance of SLNB is that it can predict the state of axillary nodes and lead the patients axillary node negative to avoid the ALND. The influential factors of SLN locating and biopsy were different by different specialists, and there are many controversy. In this article, we explore the factors that might affect the success rate of sentinel lymph node biopsy with living dye in patients with breast cancer.MethodsThe 89 patients with breast cancer were detected sentinel lymph nodes using methylene blue. All patients have no history of axillary operation, adjuvant chemotherapy, and radiotherapy. The clinical stage is M0(T_is～3N_0～2M₀),and there are 4 of Tis,29 of T₁,42 of T₂,11 of T₃,and 3 of Tx(lump resection prior to hospitalization; there are 21 patients with palpable axillary node(s),and 68 patients with non-palpable axillary node(s).After the diagnosis confirmed by pathobiology, inject the methylene blue in the subcutaneouly or subareolar. Any blue stained node was defined as a SLN. All patients with breast cancer underwent a complete axillary lymph node dissection. The sentinel lymph nodes detected were presentated by percentage, and using x² test. A P value < 0.05 is statistical significance.Results78(87.6%) were confirmed by SLNB in 89 patients. The rate of detection of SLN with non-palpable axillary node(s) was 94.12% ,and the rate of detection of SLN with palpable axillary node(s)(66.70 %) . The discrepancy is statistical significance (P<0.05). The rate of detection of SLN in the latter 64 patients is 93.75%,and the rate of detection of SLN in the first 25 cases was 72.00%. The discrepancy is statistical significance (P<0.05). The rate of detection of SLN with other factors such as ages of patients, tumor size, location of lumpectomy, location of injecton, pathologic classification, the status of Cerb-B2, the status of ER is not statistically significant.Conclusions1. Axillary lymphadenectasis has an effect in the rate of detection of SLN; the training curve also has an effect in the rate of detection of SLN. 2. Dye-guided sentinel lymph node biopsy in breast cancer patients is a rather precise method for locating SLN.3. Sentinel lymph node biopsy can be use to guide the surgical treatment of breast cancer.