核素法行乳腺癌前哨淋巴通道显像的研究

The study on sentinel lymphatic channel (SLC)by using technetium 99m sulfur colloid in breast cancer patients

目的:通过乳晕下注射99mTc-SC行乳腺癌术前淋巴显像,探讨前哨淋巴通道(SLC)的走行特点。方法:对101例Ⅰ-Ⅱ期乳腺癌患者(包括3例多中心性/多灶性乳腺癌)行术前淋巴显像,其中成功显示SLC者88例,测量并记录SLC的外侧角即θe。结果:94.32%(n=83)的病例有一条主要的SLC,5.68%(n=5)的病例有两条SLCs。SLC主要走行在乳腺的外上象限(n=87,占98.86%),其中7例(7.95%)的θe角为0°-30°,31例(35.23%)的θe角为31°-60°,49例(55.68%)的θe角为61°-90°,所有SLC均终止于腋窝SLN,未发现有内乳区SLN。结论:术前淋巴显像通过乳晕下注射99mTc-SC,显示SLC的走行特点为:主要起源于乳晕的外上边缘、穿越乳腺的外上象限、终止于腋窝SLN。SLC的走行特点与原发肿瘤的部位和数量无关。通过术前对SLC行走路线和数量的认识有助术中正确定位SLN,提高SLNB的检出率、减少假阴性率。

Objective：To determine direction, route and number of SLC and its relationship with SLN by using subareolar injection of technetium 99m sulfur colloid （99mTc -SC）. Methods： Lymphoscintigraphy was performed in 101 stage Ⅰ-Ⅱ breast cancer cases, three of which were multifocal and muhicentric tumors. SLC was identified successfully in 88 cases and the exit angle （0e） was tested. Results： One SLC was identified in 94.32% cases （n = 83 ）, and two SLCs were identified in 5.68% cases （ n = 5 ）. Most SLC （ n = 87 ） traveled through the upper, outer quadrant of the breast. 7.95% of SLC exited the areola with θe = 0° - 30° （ n = 7）, 35.23% exited the areola with θe = 31° - 60 ° （ n = 31 ）, and 55.68 % exited the areola with θe = 61° - 90° （ n = 49）. Each SLC terminated at the axillary SLN,with no internal mammary SLN found. Conclusion： Most SLC exited the areola, traveled through the upper, outer quadrant and terminated at the axillary SLN, regardless of the location and number of the primary tumor. By using subareolar injection of 99mTc - SC, SLC and SLN can be identified preoperatively and located accurately intraoperatively. The detection rate of SLC can be improved and the false negative rate of SLNB can be reduced.