新型示踪剂^(99m)Tc-利妥昔用于原发性乳腺癌前哨淋巴结活检的初步研究

Preliminary study of new imaging agent, ^(99m)Tc-Rituximab, for sentinel lymph node biopsy of primary breast cancer

目的探讨新型示踪剂99mTc-利妥昔用于原发性乳腺癌前哨淋巴结活检(SLNB)的可行性和效果。方法采用99mTc-利妥昔配合染料专利蓝对85例原发性乳腺癌进行前哨淋巴结活检,并对前哨淋巴结(SLN)进行常规病理检查和以细胞角蛋白19为标志物的免疫组化检查,以确定有无SLN转移。结果99mTc利妥昔联合专利蓝检测SLN,检测成功率为96%(82/85)。SLN转移阳性30例(37%,30/82),其中24例(80%,24/30)常规病理检查为转移阳性,6例(20%,6/30)为免疫组化检出的微转移。30例SLN有转移患者中,12例同时存在其他腋下淋巴结转移,18例为惟一转移淋巴结。1例SLN转移假阴性。灵敏度为97%(30/31),特异度为100%(51/51),准确度为99%(81/82),假阴性率为3%(1/30),阴性预测值为98%(51/52),阳性预测值为100%(31/31)。内乳淋巴结显像11例,活检病理检查均为转移阴性。结论99mTc利妥昔可使SLN显像持久,有利于SLNB的时间选择;99mTc利妥昔联合专利蓝行SLNB的准确率、敏感度较高。

bjective To study the feasibility and effects of new imaging agent, ^99mTc- Rituximab, for sentinel lymph nodes biopsy （SLNB） of primary breast cancer. Methods SLNB were performed in eighty-five primary breast cancer patients using ^99mTc- Rituximab combined with patent blue. Metastases in sentinel lymph nodes were detected with routine pathologic and immunohistochemistry method. Results The successful rate of SLNB using combining method of ^99mTc- Rituximab and patent blue was 96% （82/85）. Thirty cases of SIN （37%, 30/82） were metastasis positive, including twenty-four positive cases by HE staining and six by immunohistochemistry method. SLN was the only metastasis lymph nodes in 18/30 cases. One case has false negative SLN metastasis. The sensitivity and accuracy of SLNB were 97% （ 30/31 ） and 99% （81/82）. The specificity was 100% （51/51）. The false negative rate was 3% （1/30） and the negative predictive value was 98% （51/52）. The positive predictive value was 100% （31/31）. Internal mammary sentinel lymph node lymphoscintigraphy was positive in eleven cases but all of them were confirmed metastases negative by pathologic examination. Conclusions ^99mTc- Rituximab, as a new imaging agent, can keep SLN imaging durable and can make SLNB more convenient. Through primary clinical manifestation, higher sensitivity and accuracy could obtained by combining method of ^99mTc- Rituximab and patent blue for SLNB of primary breast cancer.