Veronesi U, Paganelli G, Viale G, Galimberti V, Luini A, Zurrida S, Robertson C, Sacchini V, Veronesi P, Orvieto E, De Cicco C, Intra M, Tosi G, Scarpa D
Senology Division, Istituto Europeo di Oncologia, Milan, Italy.
J Natl Cancer Inst. 1999 Feb 17;91(4):368-73. doi: 10.1093/jnci/91.4.368.
Axillary lymph node dissection is an established component of the surgical treatment of breast cancer, and is an important procedure in cancer staging; however, it is associated with unpleasant side effects. We have investigated a radioactive tracer-guided procedure that facilitates identification, removal, and pathologic examination of the sentinel lymph node (i.e., the lymph node first receiving lymphatic fluid from the area of the breast containing the tumor) to predict the status of the axilla and to assess the safety of foregoing axillary dissection if the sentinel lymph node shows no involvement.
We injected 5-10 MBq of 99mTc-labeled colloidal particles of human albumin peritumorally in 376 consecutive patients with breast cancer who were enrolled at the European Institute of Oncology during the period from March 1996 through March 1998. The sentinel lymph node in each case was visualized by lymphoscintigraphy, and its general location was marked on the overlying skin. During breast surgery, the sentinel lymph node was identified for removal by monitoring the acoustic signal from a hand-held gamma ray-detecting probe. Total axillary dissection was then carried out. The pathologic status of the sentinel lymph node was compared with that of the whole axilla.
The sentinel lymph node was identified in 371 (98.7%) of the 376 patients and accurately predicted the state of the axilla in 359 (95.5%) of the patients, with 12 false-negative findings (6.7%; 95% confidence interval = 3.5%-11.4%) among a total of 180 patients with positive axillary lymph nodes.
Sentinel lymph node biopsy using a gamma ray-detecting probe allows staging of the axilla with high accuracy in patients with primary breast cancer. A randomized trial is necessary to determine whether axillary dissection may be avoided in those patients with an uninvolved sentinel lymph node.
腋窝淋巴结清扫术是乳腺癌外科治疗的既定组成部分，也是癌症分期的重要步骤；然而，它会带来令人不适的副作用。我们研究了一种放射性示踪剂引导的手术方法，该方法有助于前哨淋巴结（即首先接收来自含有肿瘤的乳房区域淋巴液的淋巴结）的识别、切除及病理检查，以预测腋窝状态，并在该前哨淋巴结未受累时评估省略腋窝清扫术的安全性。
1996年3月至1998年3月期间，我们在欧洲肿瘤研究所连续纳入的376例乳腺癌患者中，在肿瘤周围注射了5 - 10 MBq的99mTc标记的人白蛋白胶体颗粒。通过淋巴闪烁显像观察每例患者的前哨淋巴结，并在其上方皮肤标记其大致位置。在乳房手术期间，通过监测手持γ射线探测探头的声学信号来识别前哨淋巴结以便切除。然后进行全腋窝清扫术。将前哨淋巴结的病理状态与整个腋窝的病理状态进行比较。
376例患者中有371例（98.7%）识别出了前哨淋巴结，其中359例（95.5%）患者的前哨淋巴结准确预测了腋窝状态，在总共180例腋窝淋巴结阳性患者中有12例假阴性结果（6.7%；95%置信区间 = 3.5% - 11.4%）。
使用γ射线探测探头进行前哨淋巴结活检可在原发性乳腺癌患者中高精度地对腋窝进行分期。有必要进行一项随机试验来确定在那些前哨淋巴结未受累的患者中是否可以避免腋窝清扫术。
