Gennari R, Galimberti V, De Cicco C, Zurrida S, Zerwes F, Pigatto F, Luini A, Paganelli G, Veronesi U
Department of Surgery, European Institute of Oncology, Milan, Italy.
J Am Coll Surg. 2000 Jun;190(6):692-8; discussion 698-9. doi: 10.1016/s1072-7515(00)00272-6.
Management of clinically occult breast lesions is still a major point of debate. Several techniques (eg, skin projection, guidewire localization) have been proposed, but all of them have technical limitations.
The aim of this study was to assess the efficacy of a new method to locate occult breast lesions using technetium-99m (99mTc)-labeled colloid particles of human serum albumin (radioguided occult lesion localization). We studied 647 consecutive patients (mean age 51.3 years; range 25 to 77 years) with nonpalpable breast lesions detected mammographically or by ultrasonography. Within 24 hours before operation, 3.7 MBq (0.1 mCi) of 99mTc-labeled colloid was injected directly into the center of the lesion using stereotactic mammographic guidance (when only microcalcifications were present) or ultrasonographic guidance (for opacities). Excision biopsy was performed with a gamma-detecting probe. After excision, the area was checked for residual radioactivity and the specimen was radiographed to verify complete removal of the lesion. The material was then sent for pathologic examination. The absorbed dose to the inoculated area and the external irradiation to staff were also determined.
In all 647 patients, the "hot spot" was located easily and quickly. X-ray and scintigraphy of the specimen verified the presence and centricity of the lesion in all patients but three (99.5%). Pathologic examination revealed 340 cancer lesions (52.6%). Of these patients, 339 (99.7%) were treated by breast-conserving operations and one (0.3%) received a modified radical mastectomy. No major surgical or postoperative complications were encountered. No recurrences were documented during follow-up. The absorbed dose to the breast and other tissue was negligible (0.03 +/- 0.02 mGy/MBq), as was the dose to the surgeon's hands (7.5 +/- 5.0 microSv/h). The latter dose represents 0.015% and 0.002% of the recommended limits of the European Community for the general population and for exposed workers, respectively.
Radioguided occult lesion localization seems to offer a simple and reliable method to locate occult breast lesions with a gamma-detecting probe, allowing complete removal of the lesion in 99.5% of patients. Because of the small quantity of radioactivity, the procedure is safe for both patients and medical staff.
临床隐匿性乳腺病变的处理仍是一个主要的争论点。已经提出了几种技术（例如，皮肤投影、导丝定位），但所有这些技术都有技术局限性。
本研究的目的是评估一种使用锝-99m（99mTc）标记的人血清白蛋白胶体颗粒定位隐匿性乳腺病变的新方法的有效性（放射性引导隐匿性病变定位）。我们研究了647例连续的患者（平均年龄51.3岁；范围25至77岁），这些患者通过乳腺X线摄影或超声检查发现有不可触及的乳腺病变。在手术前24小时内，使用立体定向乳腺X线摄影引导（当仅存在微钙化时）或超声引导（用于不透明病变）将3.7 MBq（0.1 mCi）的99mTc标记胶体直接注入病变中心。使用γ探测探头进行切除活检。切除后，检查该区域是否有残留放射性，并对标本进行放射照相以验证病变是否完全切除。然后将材料送去进行病理检查。还确定了接种区域的吸收剂量和工作人员的外照射剂量。
在所有647例患者中，“热点”很容易且快速地被定位。标本的X线和闪烁显像在除3例患者外的所有患者中（99.5%）证实了病变的存在和中心位置。病理检查发现340个癌性病变（52.6%）。在这些患者中，339例（99.7%）接受了保乳手术，1例（0.3%）接受了改良根治性乳房切除术。未遇到重大手术或术后并发症。随访期间未记录到复发情况。乳腺和其他组织的吸收剂量可忽略不计（0.03±0.02 mGy/MBq），外科医生手部的剂量也是如此（7.5±5.
