Mateos J J, Vidal-Sicart S, Zanón G, Pahisa J, Fuster D, Martín F, Ortega M, Fernández P, Pons F
Nuclear Medicine Department of the Hospital Clínic de Barcelona, Spain.
Nucl Med Commun. 2001 Jan;22(1):17-24. doi: 10.1097/00006231-200101000-00003.
Sentinel lymph node (SLN) biopsy has been widely used in the management of melanoma and breast cancer. The aims of this study were (1) to compare the results obtained with the two main injection techniques, the peritumoural and subdermal; and (2) to determine the reliability of SLN to predict the regional lymph node status.
We prospectively studied 80 women (mean age 56 years) with breast cancer. Thirty-four of them were T1 and the remaining 46 were T2. Patients were divided into two groups. Group A, 36 patients were injected subdermally, surrounding the tumour site. Group B, 44 patients were injected peritumourally guided by ultrasound if non-palpable. Planar images were performed 15 min after the injection and continued until SLN identification. Before surgery, blue dye injection was administered similarly to the radiocolloid. After incision, a hand-held gamma probe was used to reach the SLN. All nodes harvested were analysed by classic pathology techniques.
Overall, lymphoscintigraphy allowed the detection of SLN in 75/80 patients (94%). All subdermal lymphoscintigraphies were positive (36/36) compared with 89% of peritumoural (39/44). Blue dye detected SLN in 23/31 patients (74%) after subdermal injection and in 24/34 patients (71%) after peritumoural injection. The sensitivity to localize the SLN with lymphoscintigraphy+blue dye+gamma probe was 92% (33/36) within the subdermal group and 91% (40/44) within the peritumoural group. Overall, five false negative SLN were found. All of these corresponded to T2 tumours with a size greater than 2.5 cm. The negative predictive value and the accuracy were 93% and 94%, respectively, for the subdermal group and 90% and 93% for the peritumoural group.
(1) Our results indicate that both techniques have similar results. However, we suggest that T2 tumours with a size greater than 2.5 cm should be excluded from the SLN technique, in order to improve the accuracy and negative predictive value. (2) Lymphoscintigraphy is essential for visualizing the SLN, and blue dye can be helpful when the gamma probe does not localize the SLN.
前哨淋巴结（SLN）活检已广泛应用于黑色素瘤和乳腺癌的治疗。本研究的目的是：（1）比较两种主要注射技术（肿瘤周围注射和皮下注射）所获得的结果；（2）确定SLN预测区域淋巴结状态的可靠性。
我们对80例乳腺癌女性患者（平均年龄56岁）进行了前瞻性研究。其中34例为T1期，其余46例为T2期。患者被分为两组。A组，36例患者在肿瘤部位周围进行皮下注射。B组，44例不可触及的患者在超声引导下进行肿瘤周围注射。注射后15分钟进行平面显像，并持续至识别出SLN。手术前，以与放射性胶体类似的方式进行蓝色染料注射。切开后，使用手持式γ探测器找到SLN。所有切除的淋巴结均采用经典病理学技术进行分析。
总体而言，淋巴闪烁显像在80例患者中的75例（94%）检测到了SLN。所有皮下淋巴闪烁显像均为阳性（36/36），而肿瘤周围注射的阳性率为89%（39/44）。皮下注射后，蓝色染料在31例患者中的23例（74%）检测到SLN，肿瘤周围注射后在34例患者中的24例（71%）检测到SLN。皮下注射组中，淋巴闪烁显像+蓝色染料+γ探测器定位SLN的敏感性为92%（33/36），肿瘤周围注射组为91%（40/44）。总体而言，发现了5例假阴性SLN。所有这些均对应于大小大于2.5 cm的T2期肿瘤。皮下注射组的阴性预测值和准确性分别为93%和94%，肿瘤周围注射组为90%和93%。
（1）我们的结果表明两种技术的结果相似。然而，我们建议，为了提高准确性和阴性预测值，大小大于2.5 cm的T2期肿瘤应排除在SLN技术之外。（2）淋巴闪烁显像对于显示SLN至关重要，当γ探测器未能定位SLN时，蓝色染料可能会有所帮助。
