Boolbol S K, Fey J V, Borgen P I, Heerdt A S, Montgomery L L, Paglia M, Petrek J A, Cody H S, Van Zee K J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Surg Oncol. 2001 Jan-Feb;8(1):20-4. doi: 10.1007/s10434-001-0020-x.
The combined approach of radioactive tracer and blue-dye mapping of sentinel lymph nodes (SLN) has evolved into a safe and effective alternative to routine axillary node dissection in specific patient populations with breast carcinoma. The optimal route of injection for the isotope has not been clearly defined. To assess the intradermal route of isotope injection, we prospectively evaluated 100 patients with biopsy-proven invasive breast carcinoma with SLN biopsy followed by planned axillary node dissection.
All patients were given an intradermal injection of Tc-99m sulfur colloid and an intraparenchymal injection of blue dye. All patients underwent a complete axillary node dissection. Each sentinel node was serially sectioned and examined by immunohistochemistry.
Sentinel nodes were successfully identified in 99% of cases. Forty-six patients had axillary metastases; of these, four had falsely negative sentinel nodes (false-negative rate, 9%). The false-negative rate was 0 of 24 (0%) for T1 tumors, 2 of 18 (11%) for T2 tumors, and 2 of 4 (50%) for T3 tumors. Three of four patients with false negatives had palpable, clinically suspicious axillary nodes found intraoperatively. If these cases are excluded, the accuracy of the procedure was 100% for T1 and T2 tumors. Of the 42 positive axillae identified by SLNB (true positives), 40 were localized using the intradermal injection of radioisotope; in 13 of these cases, this was the only method that identified the true-positive node.
These data demonstrate that intradermal injection of radioactive tracer is an effective method of localizing the SLN in cases involving small breast cancers. Further investigation is warranted before this technique is adopted for use in larger breast cancers. Intraoperative examination and biopsy of any suspicious nonsentinel nodes are critical.
对于特定乳腺癌患者群体，放射性示踪剂与前哨淋巴结（SLN）蓝染法相结合的方法已发展成为一种安全有效的替代常规腋窝淋巴结清扫术的方法。同位素的最佳注射途径尚未明确界定。为评估同位素皮内注射途径，我们前瞻性地评估了100例经活检证实为浸润性乳腺癌的患者，这些患者接受了SLN活检，随后计划进行腋窝淋巴结清扫术。
所有患者均接受了Tc-99m硫胶体皮内注射和蓝色染料实质内注射。所有患者均接受了完整的腋窝淋巴结清扫术。每个前哨淋巴结均进行连续切片并通过免疫组织化学检查。
99%的病例成功识别出前哨淋巴结。46例患者有腋窝转移；其中4例前哨淋巴结为假阴性（假阴性率为9%）。T1肿瘤患者中24例的假阴性率为0（0%），T2肿瘤患者中18例有2例（11%），T3肿瘤患者中4例有2例（50%）。4例假阴性患者中有3例术中发现可触及的、临床上可疑的腋窝淋巴结。如果排除这些病例，T1和T2肿瘤的该手术准确性为100%。在通过SLNB识别出的42个阳性腋窝（真阳性）中，40个是通过放射性同位素皮内注射定位的；在其中13例中，这是识别真阳性淋巴结的唯一方法。
这些数据表明，在涉及小乳腺癌的病例中，放射性示踪剂皮内注射是定位SLN的有效方法。在将该技术应用于更大的乳腺癌之前，有必要进行进一步研究。术中对任何可疑的非前哨淋巴结进行检查和活检至关重要。
