Cody H S, Fey J, Akhurst T, Fazzari M, Mazumdar M, Yeung H, Yeh S D, Borgen P I
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Surg Oncol. 2001 Jan-Feb;8(1):13-9. doi: 10.1007/s10434-001-0013-9.
The hypothesis that sentinel lymph node (SLN) mapping in breast cancer patients is optimized by combining blue dye and isotope is reasonable and intuitive. Despite this, few studies examine in detail the factors contributing to the success of these techniques, either individually or in combination.
During a time period of 21/2 years, 1000 consecutive patients at Memorial Sloan-Kettering Cancer Center had SLN mapping performed by using both blue dye and isotope, with preoperative lymphoscintigraphy (LSG). Among the 966 patients with invasive cancer, 12 variables were examined for their correlation with the success of SLN localization by blue dye, by isotope, and by the combined method, using univariate and multivariate models.
By univariate analysis, blue dye success was more frequent in association with: a positive LSG (P = .02), age < or = 60 (P < .0005), a previous surgical biopsy (P = .03), and an outer quadrant tumor (P < .0005). Isotope success was more frequent with a positive LSG (P < .0005), age < or = 60 (P = .004), and intradermal isotope injection (P < .0005). Combined (dye and/or isotope) success was more frequent when there was a positive LSG (P < .0005), age < or = 60 (P = .006) and intradermal isotope injection (P < .0005). In multivariate analysis, blue dye success remained uniquely associated with outer quadrant tumor location (P < .0005), and isotope success was uniquely associated with intradermal isotope injection (P = .012). Combined success was more frequent with a positive LSG (P < .0005), age < or = 60 (P = .033), and intradermal isotope injection (P = .003).
The five variables associated with successful SLN localization by blue dye or by isotope overlap but are not identical. Only three of these, intradermal isotope injection, a positive LSG, and age < 60, predicted success by the dye-isotope combination in the multivariate model. Dye and isotope complement each other, and SLN biopsy for breast cancer should use both.
通过联合使用蓝色染料和同位素来优化乳腺癌患者前哨淋巴结（SLN）定位的假说合理且直观。尽管如此，很少有研究详细探讨这些技术单独或联合使用时成功的影响因素。
在2年半的时间里，纪念斯隆凯特琳癌症中心的1000例连续患者通过使用蓝色染料和同位素并结合术前淋巴闪烁显像（LSG）进行SLN定位。在966例浸润性癌患者中，通过单变量和多变量模型，检查了12个变量与蓝色染料、同位素以及联合方法进行SLN定位成功之间的相关性。
单变量分析显示，蓝色染料定位成功更常见于以下情况：LSG阳性（P = 0.02）、年龄≤60岁（P < 0.0005）、既往手术活检（P = 0.03）以及外象限肿瘤（P < 0.0005）。同位素定位成功更常见于LSG阳性（P < 0.0005）、年龄≤60岁（P = 0.004）以及皮内注射同位素（P < 0.0005）。联合（染料和/或同位素）定位成功更常见于LSG阳性（P < 0.0005）、年龄≤60岁（P = 0.006）以及皮内注射同位素（P < 0.0005）。多变量分析中，蓝色染料定位成功仅与外象限肿瘤位置相关（P < 0.0005），同位素定位成功仅与皮内注射同位素相关（P = 0.012）。联合定位成功更常见于LSG阳性（P < 0.0005）、年龄≤60岁（P = 0.033）以及皮内注射同位素（P = 0.003）。
与蓝色染料或同位素成功进行SLN定位相关的五个变量有重叠但并不完全相同。在多变量模型中，其中只有皮内注射同位素、LSG阳性和年龄<60岁这三个变量可预测染料 - 同位素联合定位的成功。染料和同位素相互补充，乳腺癌的SLN活检应同时使用两者。
