McMasters K M, Wong S L, Martin R C, Chao C, Tuttle T M, Noyes R D, Carlson D J, Laidley A L, McGlothin T Q, Ley P B, Brown C M, Glaser R L, Pennington R E, Turk P S, Simpson D, Cerrito P B, Edwards M J
Division of Surgical Oncology, J. Graham Brown Cancer Center, Department of Surgery, Minneapolis, Minnesota, USA.
Ann Surg. 2001 May;233(5):676-87. doi: 10.1097/00000658-200105000-00012.
To determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer.
The optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique.
The University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1-2, N0 breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radioactivity of the nodes. One-way analysis of variance and chi-square tests were used for statistical analysis.
A total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94%) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5%, 7.8%, and 6.5% (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five- to sevenfold higher with the dermal injection technique compared with peritumoral injection.
Dermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five- to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve.
确定用于乳腺癌前哨淋巴结（SLN）活检的最佳放射性胶体注射技术。
尚未确定用于乳腺癌SLN活检的最佳放射性胶体注射技术。大多数研究采用瘤周注射放射性胶体。虽然有人提出真皮注射放射性胶体，但尚无已发表的数据来确定与该技术相关的假阴性率。
路易斯维尔大学乳腺癌前哨淋巴结研究是一项涉及229名外科医生的多机构研究。临床分期为T1-2、N0的乳腺癌患者符合该研究条件。所有患者均接受SLN活检，随后进行Ⅰ/Ⅱ级腋窝淋巴结清扫。放射性胶体的瘤周、皮下或真皮注射由主刀医生自行决定。大多数患者同时进行瘤周注射异硫蓝染料。比较SLN识别率和假阴性率。计算经皮和体外放射性SLN计数与最终本底计数的比值，作为淋巴结相对放射性程度的指标。采用单因素方差分析和卡方检验进行统计分析。
共纳入2206例患者。分别对1074例、297例和511例患者进行了放射性胶体的瘤周、皮下或真皮注射。大多数接受放射性胶体注射的患者（94%）也接受了瘤周蓝色染料注射。与放射性胶体的皮下或瘤周注射相比，真皮注射提高了SLN识别率。瘤周、皮下和真皮注射技术的假阴性率分别为9.5%、7.8%和6.5%（无显著性差异）。与瘤周注射相比，真皮注射技术使SLN的相对放射性程度高五至七倍。
与瘤周或皮下注射相比，真皮注射放射性胶体显著提高了SLN识别率。使用真皮注射也可将假阴性率降至最低。真皮注射还与放射性比瘤周注射高五至七倍的SLN相关，这简化了SLN定位并可能缩短学习曲线。
