Paganelli G, De Cicco C, Chinol M
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
Recent Results Cancer Res. 2000;157:121-9. doi: 10.1007/978-3-642-57151-0_10.
The concept of the sentinel lymph node (SN) represents an important contribution to guide appropriate surgery of cancer. Diagnostic non-invasive or minimally invasive procedures that provide accurate preoperative staging of the lymph node status are badly needed. The technique of SN biopsy, first developed with the purpose to select melanoma patients for regional node dissection, has been extended to other malignancies. Initial studies in breast carcinoma, conducted with vital blue dye, showed that the SN concept was biologically valid, although SN was missed in up to 30%-40% of cases. If a radioactive tracer is injected close to the tumor, then the SN can be identified by lymphoscintigraphy (LS), and a gamma ray detecting probe (GDP) can be used to locate the skin projection of SN and assist biopsy. These techniques are already used successfully in melanoma and breast carcinoma where the various parameters involved, such as the size of the radioactive particles, the injection site and injection volume, have recently been optimized. In a large series of breast cancer patients, the overall predictive value of the SNs biopsy guided by LS and GDP was 96.8%; in patients with small carcinomas (< 1.2 cm diameter), the concordance between SN and axillary status was 98.6%. In patients with melanoma, LS combined with GDP showed itself to be superior to the blue dye mapping. LS associated with GDP allowed the detection of SN in 98% of cases and 72 SNs in 54 basins were localized. Using blue dye instead, SN was stained only in 80% of patients (50 SNs in 40 basins). Lymphoscintigraphic techniques have shown promising results also in tumors such as vulva and tongue. In conclusion, LS is a simple nuclear medicine technique, relatively inexpensive and well accepted by patients. SN biopsy guided by a GDP is becoming widely adopted for a variety of neoplasms, contributing significantly to the search for less aggressive treatments in patients with early stages of cancer.
前哨淋巴结（SN）的概念为指导癌症的合理手术做出了重要贡献。目前急需能够准确提供术前淋巴结状态分期的非侵入性或微创诊断程序。SN活检技术最初是为选择黑色素瘤患者进行区域淋巴结清扫而开发的，现已扩展到其他恶性肿瘤。最初在乳腺癌中使用活性蓝色染料进行的研究表明，尽管在高达30%-40%的病例中会遗漏SN，但SN概念在生物学上是有效的。如果在肿瘤附近注射放射性示踪剂，那么可以通过淋巴闪烁显像（LS）识别SN，并且可以使用伽马射线探测探头（GDP）来定位SN的皮肤投影并辅助活检。这些技术已成功应用于黑色素瘤和乳腺癌，其中涉及的各种参数，如放射性颗粒的大小、注射部位和注射体积，最近已得到优化。在一大系列乳腺癌患者中，由LS和GDP引导的SN活检的总体预测价值为96.8%；在小癌（直径<1.2 cm）患者中，SN与腋窝状态的一致性为98.6%。在黑色素瘤患者中，LS联合GDP显示优于蓝色染料定位。LS与GDP联合使用在98%的病例中检测到SN，在54个区域定位了72个SN。而使用蓝色染料时，仅80%的患者（40个区域中的50个SN）的SN被染色。淋巴闪烁显像技术在外阴和舌等肿瘤中也显示出有前景的结果。总之，LS是一种简单的核医学技术，相对便宜且患者易于接受。由GDP引导的SN活检正被广泛应用于各种肿瘤，为寻找早期癌症患者侵袭性较小的治疗方法做出了重大贡献。
