Tuthill L L, Reynolds H E, Goulet R J
Department of Radiology, Indiana University School of Medicine, Indiana University Hospital, 550 N. University Blvd., Rm. 0279, Indianapolis, IN 46202, USA.
AJR Am J Roentgenol. 2001 Feb;176(2):407-11. doi: 10.2214/ajr.176.2.1760407.
The purpose of this study was to determine the technical success rate of sentinel node biopsy with lymphoscintigraphy in women with breast cancer and the frequency with which sentinel node biopsy obviated axillary dissection. Factors affecting the success rate of sentinel node biopsy and lymphoscintigraphy were also evaluated.
Retrospective review revealed 119 women with breast cancer who underwent lymphoscintigraphy and sentinel node biopsy at our institution during the study period. A planned axillary dissection was performed in 13 of the first 16 patients; otherwise, axillary dissection was only performed if tumor was present in sentinel nodes or if the sentinel node biopsy was unsuccessful.
Sentinel node biopsy was successful in 96% of patients, and sentinel node metastases were found in 20%. In 78% of patients, a negative sentinel node biopsy obviated axillary dissection. Prior excisional biopsy was not associated with a failed sentinel node biopsy (p = 0.750) but was associated with failed lymphoscintigraphy (p = 0.01). Successful lymphoscintigraphy was associated with successful sentinel node biopsy (p < 0.0001). No association was found between the histology or size of the tumor and a failed sentinel node biopsy (p = 0.46 and p = 0.1, respectively) or failed lymphoscintigraphy (p = 0.36 and p = 0.47, respectively).
Sentinel node biopsy guided by lymphoscintigraphy, intraoperative gamma probe, and isosulfan blue dye is an effective alternative to axillary dissection in patients with breast cancer. Lymphoscintigraphy improved the success rate of sentinel node biopsy. Large tumor size or prior excisional biopsy should not prevent patients from having sentinel node biopsy.
本研究旨在确定乳腺癌女性患者前哨淋巴结活检联合淋巴闪烁显像的技术成功率，以及前哨淋巴结活检避免腋窝淋巴结清扫的频率。还评估了影响前哨淋巴结活检和淋巴闪烁显像成功率的因素。
回顾性研究发现，在研究期间，119例乳腺癌女性患者在我院接受了淋巴闪烁显像和前哨淋巴结活检。前16例患者中有13例计划进行腋窝淋巴结清扫；否则，仅在前哨淋巴结有肿瘤或前哨淋巴结活检不成功时才进行腋窝淋巴结清扫。
96%的患者前哨淋巴结活检成功，20%发现前哨淋巴结转移。78%的患者前哨淋巴结活检阴性避免了腋窝淋巴结清扫。既往切除活检与前哨淋巴结活检失败无关（p = 0.750），但与淋巴闪烁显像失败有关（p = 0.01）。淋巴闪烁显像成功与前哨淋巴结活检成功相关（p < 0.0001）。未发现肿瘤组织学类型或大小与前哨淋巴结活检失败（分别为p = 0.46和p = 0.1）或淋巴闪烁显像失败（分别为p = 0.36和p = 0.47）之间存在关联。
淋巴闪烁显像、术中γ探测仪和异硫蓝染料引导下的前哨淋巴结活检是乳腺癌患者腋窝淋巴结清扫的有效替代方法。淋巴闪烁显像提高了前哨淋巴结活检的成功率。肿瘤体积大或既往有切除活检不应妨碍患者进行前哨淋巴结活检。
