Valdés-Olmos R A, Jansen L, Hoefnagel C A, Nieweg O E, Muller S H, Rutgers E J, Kroon B B
Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam.
J Nucl Med. 2000 Sep;41(9):1500-6.
The aim of this study was to evaluate the findings of mammary lymphoscintigraphy by a single intratumoral injection in 150 patients with breast carcinoma: 100 patients (group A) investigated in the validation phase of the study and 50 (group B) studied after the tracer dose was optimized.
Immediately after injection of 99mTc-nanocolloid using a 25-gauge needle and a 0.2-mL volume, simultaneous anterior and lateral images were acquired with a dual-head gamma camera during 20 min followed by sequential static anterior and prone lateral breast images after 30 min and after 2 and 4 h. 57Co-assisted skin marking defined the sentinel node location for subsequent gamma probe, blue dye-guided sentinel node biopsy.
In group A (mean dose, 61.6 MBq; range, 42-88 MBq) scintigraphy revealed lymph nodes in 83 patients (83%), with an increase in the rate of visualization from 72% for the first 40 patients to 90% for the last 60; patient age (P = 0.01) and administered tracer dose (P = 0.04) were found to be significant factors for visualization, with optimal results obtained from doses higher than 65 MBq. Lymph nodes were visible in 34 patients (41%) during the first 30 min after injection, whereas in 49 patients appearance occurred at 2-4 h. A total of 97 lymphatic basins were visualized (80 axillary, 3 clavicular, 14 internal mammary). In group B (mean dose, 90.8 MBq; range, 68-124 MBq), the visualization rate was 94%, with early lymph node appearance in 27 patients (57%) and a total of 53 basins (45 axillary, 8 internal mammary). In combination with intraoperative blue dye mapping and y probing, the identification rate increased to 90% in group A and 98% in group B. Prone lateral images contributed to identification of intramammary lymph nodes in a total of 14 patients and axillary nodes close to the injection site in 8 other patients.
Mammary lymphoscintigraphy by single intratumoral injection is a valid method for lymphatic mapping and identification of both axillary and nonaxillary sentinel nodes. Lymph node visualization appears to be improved with higher tracer doses. The compactness of the injection site enables high-quality additional lateral images that can depict intramammary or axillary lymph nodes adjacent to the injection site.
本研究的目的是评估150例乳腺癌患者通过单次瘤内注射进行乳腺淋巴闪烁显像的结果：100例患者（A组）在研究的验证阶段接受检查，50例（B组）在示踪剂剂量优化后进行研究。
使用25号针头注射0.2 mL体积的99mTc-纳米胶体后，立即用双头γ相机在20分钟内采集前后位和侧位同步图像，然后在30分钟、2小时和4小时后依次采集乳腺前后位和俯卧位侧位静态图像。用57Co辅助皮肤标记确定前哨淋巴结位置，以便随后进行γ探针引导、蓝色染料引导的前哨淋巴结活检。
A组（平均剂量61.6 MBq；范围42 - 88 MBq）闪烁显像显示83例患者（83%）有淋巴结，显像率从最初40例患者的72%增加到最后60例患者的90%；发现患者年龄（P = 0.01）和给予的示踪剂剂量（P = 0.04）是显像的重要因素，剂量高于65 MBq时可获得最佳结果。注射后最初30分钟内34例患者（41%）可见淋巴结，而49例患者在2 - 4小时出现显像。总共显示了97个淋巴区域（80个腋窝、3个锁骨下、14个乳腺内）。B组（平均剂量90.8 MBq；范围68 - 124 MBq）的显像率为94%，27例患者（57%）出现早期淋巴结显像，总共53个区域（45个腋窝、8个乳腺内）。结合术中蓝色染料定位和γ探测，A组的识别率提高到90%，B组提高到98%。俯卧位侧位图像有助于识别总共14例患者的乳腺内淋巴结和另外8例患者靠近注射部位的腋窝淋巴结。
通过单次瘤内注射进行乳腺淋巴闪烁显像是一种有效的淋巴绘图方法，可用于识别腋窝和非腋窝前哨淋巴结。较高的示踪剂剂量似乎可改善淋巴结显像。注射部位的紧密性使得能够获得高质量的额外侧位图像，可描绘注射部位附近的乳腺内或腋窝淋巴结。
