核素淋巴显像法术中定位乳腺癌前哨淋巴结

Intra-operative radionuclide lymphatic mapping in sentinel lymph node biopsy of breast cancer

目的 研究核素淋巴显像法术前显像和术中γ探测相结合定位活检乳腺癌前哨淋巴结(SLN)的临床应用价值。方法 42例病理穿刺活检诊断为乳腺癌、肿块直径≤ 5.0cm、临床上腋淋巴结阴性的患者 ,术前在肿块或活检腔周围腺体内分 4点注射 18.5MBq/ 0 .5ml99mTc 硫胶体 (标记率 >98% ,胶体颗粒大小为 10 0～ 2 0 0nm) ,核素显像和术中γ探测仪定位活检乳腺癌SLN。所有患者行同期根治术 ,切除的SLN与区域清扫标本送常规病理检查。结果 乳腺癌SLN核素淋巴显像检出率为88.1% ,术中γ探测仪检出率为 97.6%。SLN的灵敏度为 93 .3 % (14 / 15) ,准确性为 97.6% (40 / 4 1) ,假阴性率为 6.7% (1/ 15) ,特异性为 10 0 % (2 6/ 2 6)。结论 核素淋巴显像法术前显像和术中γ探测相结合定位活检乳腺癌SLN能准确反映区域淋巴结的转移情况。改进核素显像剂品质、注射核素显像剂方式和探测方法 。

Objective To study intra-operative radionuclide lymphatic mapping in sentinel lymph node (SLN) biopsy of breast cancer. Methods Forty-two breast cancer (diameter ≤5.0 cm) patients with clinically negative axillary node wer e an alyzed. 18.5MBq/0.5ml technetium-99m labeled sulfur colloid (labeling yield>9 8% , size of colloid granule 100～200 nm) was injected into the mammary tissue arou n d the tumor or biopsy site at four points. SLN in breast cancer was detected and dissected with the help of lymphoscintigraphy and intra-operative γ probe. Ro utine lymph node dissection was performed for all patients. Results The detection rate was 88.1% in lymphoscintigraphy and 97.6% in intra-operative γ probe detection for SLN in breast cancer. The sensitivity, accuracy, false ne g ative and specificity of SLN biopsy were 93.3% (14 in 15), 97.6% (40 in 41), 6.7 % (1 in 15) and 100% (26 in 26). Conclusion Sentinel lymph node in breast cancer, de tected by preoperative lymphoscintigraphy combined with intra-operative γ prob e , is able to predict regional lymph node metastasis. The successful rate of SLN biopsy can be raised by improvement in the quality of nuclear imaging agent, tec hnic of injection and method of measurement.