Borgstein P J, Meijer S, Pijpers R J, van Diest P J
Department of Surgical Oncology, Nuclear Medicine, and Pathology, Academic Hospital of the Vrije Universiteit, Amsterdam, The Netherlands.
Ann Surg. 2000 Jul;232(1):81-9. doi: 10.1097/00000658-200007000-00012.
To simplify and improve the technique of axillary sentinel node biopsy, based on a concept of functional lymphatic anatomy of the breast.
Because of their common origin, the mammary gland and its skin envelope share the same lymph drainage pathways. The breast is essentially a single unit and has a specialized lymphatic system with preferential drainage, through select channels, to designated (sentinel) lymph nodes in the lower axilla.
These hypotheses were studied by comparing axillary lymph node targeting after intraparenchymal peritumoral radiocolloid (detected by a gamma probe) with the visible staining after an intradermal blue dye injection, either over the primary tumor site (90 procedures) or in the periareolar area (130 procedures). The radioactive content, blue coloring, and histopathology of the individual lymph nodes harvested during each procedure were analyzed.
Radiolabeled axillary nodes were identified in 210 procedures, and these were colored blue in 200 cases (94%). The targeting concordance between peritumoral radiocolloid and intradermal blue dye was unrelated to the breast tumor location or the site of dye injection. Radioactive sentinel nodes were not stained blue in 10 procedures (5%), but this mismatching could be explained by technical problems in all cases. In two cases (1%), the (pathologic) sentinel node was blue but had no detectable radiocolloid uptake.
The lessons learned from this study provide a functional concept of the breast lymphatic system and its role in metastasis. Anatomical and clinical investigations from the past strongly support these views, as do recent sentinel node studies. Periareolar blue dye injection appears ideally suited to identify the principal (axillary) metastasis route in early breast cancer. Awareness of the targeting mechanism and inherent technical restrictions remain crucial to the ultimate success of sentinel node biopsy and may prevent disaster.
基于乳腺功能性淋巴解剖学概念，简化并改进腋窝前哨淋巴结活检技术。
由于乳腺及其皮肤包膜起源相同，它们共享相同的淋巴引流途径。乳腺本质上是一个单一单元，拥有一个专门的淋巴系统，通过特定通道优先引流至腋窝下部的指定（前哨）淋巴结。
通过比较瘤周实质内注射放射性胶体（用γ探测仪检测）后腋窝淋巴结靶向情况与皮内注射蓝色染料后（在原发肿瘤部位进行90例手术，在乳晕周围区域进行130例手术）的可见染色情况，对这些假设进行研究。分析每次手术中获取的各个淋巴结的放射性含量、蓝色染色及组织病理学情况。
在210例手术中识别出放射性标记的腋窝淋巴结，其中200例（94%）被染成蓝色。瘤周放射性胶体与皮内蓝色染料的靶向一致性与乳腺肿瘤位置或染料注射部位无关。在10例手术（5%）中，放射性前哨淋巴结未被染成蓝色，但所有这些不匹配情况均可由技术问题解释。在2例手术（1%）中，（病理）前哨淋巴结呈蓝色但未检测到放射性胶体摄取。
本研究所得经验提供了乳腺淋巴系统的功能性概念及其在转移中的作用。过去的解剖学和临床研究以及近期的前哨淋巴结研究都有力地支持了这些观点。乳晕周围注射蓝色染料似乎非常适合识别早期乳腺癌的主要（腋窝）转移途径。了解靶向机制和固有的技术限制对于前哨淋巴结活检的最终成功仍然至关重要，并且可能避免灾难发生。
