乳腺癌内乳区前哨淋巴结显像新技术

A novel technique for scintigraphic visualization of internal mammary sentinel lymph nodes in breast cancer patients

目的探讨核素示踪剂的不同注射方法对内乳区前哨淋巴结（IMSLN）显像的影响。方法137例原发性乳腺癌患者根据核素示踪剂注射部位的不同分为单象限注射组（58例）和双象限注射组（79例），单象限注射组患者于乳腺原发肿瘤相关象限的腺体实质内1～2点注射^99Tc^m-硫胶体，双象限注射组患者将^99Tc^m-硫胶体注射在乳腺2个不同象限的腺体实质内。比较两组患者IMSLN显像率的差异，同时分析影响IMSLN显像率的因素。结果双象限注射组患者的IMSLN显像率（70．9％，56／79）显著高于单象限注射组（13．8％，8／58；P〈0．001）。通过联合术中γ探测仪，单象限注射组和双象限注射组均可获得较高的腋窝识别率（98．3％和98．7％，P=0．825）。大注射体积（≥0．5ml／点）和小注射体积（〈0．5ml／点）的IMSLN显像率分别为82．2％和55．9％，大注射体积（≥0．5ml／点）可以显著提高IMSLN显像率（P=0．011）。结论采用双象限、大体积和超声引导的核素示踪剂注射技术可以显著提高IMSLN显像率，使内乳区前哨淋巴结活检术的广泛应用成为可能，为乳腺癌患者提供了微创、有效的评估内乳区淋巴结状态的方法。

Objective To explore the effects of different injection techniques of radiotracer on the visualization rate of internal mammary sentinel lymph nodes （IMSIAN） in breast cancer patients. Methods A series of 137 consecutive breast cancer patients was included in this prospective study. Fifty-eight patients （group A） received the radiotracer ^99Tcm-sulphur colloid injected onl into 1-2 points in the breast parenchyma in one quadrant, and seventy-nine patients （group B） received the radiotracer injection into the breast parenchyma in two quadrants of the breast. The differences of IMSLN visualization rates of the two groups were compared and the relevant affecting factors were analyzed. Results The IMSLN visualization rate of the group B （70.9%, 56/79） was significantly higher than that of the group A （ 13.8%, 8/58 ） （P 〈0.001 ）. Both techniques seemed to be reliable to identify sentinel lymph node in the axilla （98.7% vs. 98.3% , P = 0. 825 ）. In addition, the visualization rate of internal mammary hotspots （82.2%） was more commonly seen in patients receiving injection of a larger volume of radiotracer （ 〉10.5 ml/point） than those receiving a smaller volume of radiotracer （ 〈 0.5 ml/point, 55.9%, P = 0.011 ）. Conclusions The modified injection technique （two quadrants, large volume radiotraver, and ultrasound guidance） can significantly improve the visualization rate of IMSLN. Our findings should make the biopsy of IMSLN widely implemented and provide an effective and minimally invasive technique to evaluate the internal mammary lymph node status.