^99^Tc^m-硫胶体不同制备条件及注射部位对乳腺癌前哨淋巴结检出的影响

Effects of different preparation methods and injection sites of 99Tcm-sulfur colloid on sentinel lymph node detection in breast cancer

目的 观察99^Tc^m-SC不同配置条件及注射部位对乳腺癌前哨淋巴结（SLN）检出的影响,探讨进行乳腺癌SLN活检术（SLNB）的最佳方法.方法 制备99^Tc^m-SC时将煮沸时间分别控制在3 min（显像剂1）和5 min（显像剂2）,分别测定显像剂1和显像剂2放置10 min、1h、2h和4h的放化纯及胶体大小分布.将147例乳腺癌患者用抽签法分成3组：A组40例,于乳晕周围乳腺组织内注射显像剂1;B组40例,于乳晕周围乳腺组织内注射显像剂2;C组67例,于肿块周围乳腺组织内注射显像剂2.所有患者均于术前0.5～1 h行SPECT/CT显像,并在肿块上方皮下注射蓝染料.比较3组患者腋窝及内乳SLN显像成功率及术中检出率.分别采用两独立样本t检验、单因素方差分析和r检验对相关数据进行统计学分析.结果 显像剂1和显像剂2的放化纯在放置10 min、1h、2h及4h时差异均无统计学意义（t=-0.267、-0.794、0.826和-0.977,均P＞0.05）;显像剂2与显像剂1相比,粒径＜100nm的粒子所占百分比明显减少[（65.25±3.56）％与（73.72±2.36）％;t=6.436,P＜0.05],平均有效粒径明显增大[（75.59±7.04） nm与（45.27±6.42） nm;t=7.315,P＜0.05）.3组患者内乳SLN的检出率分别为70.0％ （28/40）、47.5％ （19/40）和17.9％ （12/67）,差异有统计学意义（x2=29.525,P＜0.05）;3组患者腋窝SLN的检出率分别为100％ （40/40）、95.0％（38/40）及97.0％（65/67）,差异无统计学意义（r=2.686,P＞0.05）.结论 通过缩短煮沸时间减小99^Tc^m-SC胶体粒径,经肿瘤上方皮下注射蓝染料、乳晕周围乳腺组织内注射核素及SPECT/CT断层显像,可获得较好的乳腺癌腋窝和内乳SLN检出效果.

Objective To prospectively investigate the optimal setting for sentinel lymph node biopsy （SLNB） in patients with breast cancer by comparing the effects of different preparation methods and injection sites of 99^Tc^m-SC in sentinel lymph node （SLN） mapping and detection.Methods Two batches of 99^Tc^m-SC were prepared by boiling for 3 min （radiotracer 1） and 5 min （radiotracer 2）,respectively.Radioactive chemical purity （RCP） and size of colloid particles were measured at 10 min,1 h,2 h and 4 h after the preparation.One hundred and forty-seven patients with breast cancer were involved and randomly divided into 3 groups.Group A consisted of 40 patients with periareolar injection of radiotracer 1,group B of 40 patients with periareolar injection of radiotracer 2,and group C of 67 patients with peritumoral injection of radiotracer 2.Lymphatic mapping was performed for all patients using SPECT/CT preoperatively and blue dye was subdermally injected over the tumor.The detection rate of the axillary and internal mammary SLN was recorded.One-way analysis of variance,independent two-sample t and x2 tests were used to analyze the data.Results There was no significant difference of RCP between the two radiotracers at 10 min,1 h,2 h and 4 h after preparation （t =-0.267,-0.794,0.826 and-0.977,all P〉0.05）.Compared with radiotracer 1,the percentage of particles smaller than 100 nm in radiotracer 2 reduced significantly （（73.72±2.36） % vs （65.25±3.56）%,t=6.436,P〈0.05） and the mean effective particle size was significantly larger （（45.27±6.42） nm vs （75.59t7.04） nm,t=7.315,P〈0.05）.In groups A,B and C,the detection rate of the internal mammary SLN was 70.0% （28/40）,47.5% （19/40） and 17.9% （12/67）,respectively,with significant difference （x2=29.525,P〈0.05）.In groups A,B and C,the detection rate of the axillary SLN was 100% （40/40）,95.0% （38/40） and 97.0% （65/67）,respectively,without significant difference （x2 =2.686,P〉 0.05）.Conclusion For SLNB of patients with breast cancer,the axillary and internal mammary SLN could be better detected by SPECT/CT lymphatic mapping using radiotracer prepared with a shorter boiling time,via periareolar injection,and combined with subdermal injection of blue dye.