乳腺癌前哨淋巴结显像研究

Mammary sentinel lymphoscintigraphy in breast cancer

目的 探讨乳腺癌前哨淋巴结 (SLN)显像的方法及其临床意义。方法 对 117例早期乳腺肿瘤患者进行乳腺SLN显像 ,6例进行双侧比较和SPECT CT图像融合。其中 13例在瘤体表面皮下注射99Tcm DTPA 人血清白蛋白 [HSA ,5 5 5MBq(0 5ml) ];5 0例在瘤周乳腺组织内注射未过滤99Tcm 硫胶体 [SC ,92 5MBq(4ml) ,分 4点 ];5 4例在瘤体上部乳腺组织内一点注射相同体积SC。结果 3种方法均能快速显示SLN ,但最佳显示时间和淋巴结显示量因人而异 ,与注射深度和体积有关 ,第 3种方法能显示较多的锁骨区和内乳淋巴结。HSA、SC显像成功率分别为 6 9 2 % (30min时 )和 >84 % (2h内 )。断层图像融合有助于识别SLN和引流变异。结论 乳腺SLN显像对于正确定位SLN、识别淋巴引流变异和制定辅助治疗方案是必需的。

Objective To evaluate the methods and clinical value of mammary sentinel lymphoscintigraphy in breast cancer. Methods 117 patients with breast tumor in stage T 1～2N 0 were examined before sentinel node biopsy were considered. Some of them were compared in different injection volume at both side and several cases with SPECT/CT tomographic fusions. 13 patients were subdermally injected with 55.5 MBq (0.5 ml) 99Tcm-DTPA-human serum albumin (HSA) on the surface of the lesion, 50 patients with 92.5 MBq (4 ml) unfiltered 99Tcm-sulfur colloid (SC) in four divided doses around the lesion and 54 patients in the upper part of the lesion with the same volume of the SC in one-point-injection. Results The sentinel lymph node (SLN) could quickly be shown by any of three methods but the best time of view and number of lymph nodes differed personly and mainly affected by injection depth and volume. It was showed that the 3rd method could find more juxtaclavicular, supraclavicular and internal mammary nodes. SLN were successfully identified in 69.2% with HSA in 30 min and over 84% with SC in 2 h. SPECT/CT tomographic fusions were more helpful to recognize SLN and abnormal lymphatic drainage. Conclusion The mammary sentinel lymphoscintigraphy in breast cancer is differ from past lymphatic imaging and is essential for localizing SLN correctly, identifying abnormal lymphatic drainage and designing new therapeutic regime.