核素示踪乳腺癌前哨淋巴结活检的准确性与可行性

Radioguided sentinel lymph node biopsy in breast cancer

目的:探讨核素示踪乳腺癌前哨淋巴结(SLN)活检的准确性和可行性。方法:1999年4月-2001年10月期间,应用原发肿瘤周围皮下注射放射性核素示踪技术(99mTC-标记硫化锑胶体或99mTC-标记硫胶体),对79例早期乳腺癌患者进行前哨淋巴结活检(SLND),随后,行包括腋窝淋巴结清扫(ALND)在内的根治性手术。分析评估两种核素淋巴示踪和SLND的准确性及其影响因素。结果:75例行术前淋巴闪烁照相,淋巴结显像67例(89.33%,67/75);术中应用γ探测仪成功证实SLNs 68例,成功率为86.08%(68/79),SLN预测腋窝淋巴结状态的准确性为95.59%(65/68),假阴性率为3/36(8.33%);前28例患者有9例不能证实SLN,3例假阴性;而后51例只有2例不能证实SLN,没有假阴性。两者差异有显著性(P<0.05)。结论:本研究结果表明,99mTC-标记硫胶体作为示踪剂,手术当天(术前4-6小时)乳腺肿瘤上方皮下注药进行SLND,可以准确预测早期乳腺癌腋窝淋巴结状态。

Purpose: To evaluate the accuracy and feasibility of sentinel lymph node biopsyly by using radiopharmaceuticals for sentinel lymph node mapping. Methods: From April 1999 to October 2001, lymphatic mapping by using radiopharmaceuticals( either99mTc-antimony sulfide or 99mTc-sulfur colloid ) injection into subdermal directly overlying the tumor was performed on 79 patients with early breast cancer followed by SLND, then all patients received breast opreations including standard axillary lymph nodes dissection ( ALND). To analyze the results of SLND performed by radiopharmaceuticals. Results: The sentinel nodes were successfully identified by lymphoscintigraphy in 67 of 75 cases (89. 33%). Of the 68 patients in this study whose sentinel nodes were identified both by lymphoscintigraphy and handhold γ-probe ,65 patients' SLNs could predict the axillary status accurately(95. 59%) . The false negative rate is 8. 33%(3 of 36). We failed to identify SLN in 9 cases and found 3 cases SLNs to be false negative in the first 28 cases while there were only 2 cases whose SLN could not be identified and no false negative in the other 51 cases. The differences between the two groups were statistically significant(P <0. 05). Conclusions: As far as our study was concerned, the 99mTc-sulfur colloid injection into subdermal directly overlying the tumor 4-6 hours before SLND was a good method to provide high sentinel node retrieval rate and low false negative rate in early breast cancer.