Solorzano C C, Ross M I, Delpassand E, Mirza N, Akins J S, Kuerer H M, Meric F, Ames F C, Newman L, Feig B, Singletary S E, Hunt K K
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Ann Surg Oncol. 2001 Dec;8(10):821-7. doi: 10.1007/s10434-001-0821-y.
In sentinel lymph node (SLN) biopsy for breast cancer, many centers use same-day preoperative injection of technetium 99mTc-labeled sulfur colloid and intraoperative injection of blue dye for localization of SLNs. Same-day sulfur colloid injections can be problematic because of the variability in sulfur colloid migration times, which can lead to ineffective use of operating room time, and low SLN-to-background radioactivity ratios. We examined the utility of day-before-surgery injections of high dose 99mTc-labeled sulfur colloid injections.
The day before surgery, high-dose 99mTc-labeled sulfur colloid was injected peritumorally, and a lymphoscintigram was obtained. Intraoperatively, after injection of blue dye, a gamma probe was used to localize SLNs. Nodes that were stained blue or were highly radioactive were considered SLNs and were removed.
Lymphoscintigraphy demonstrated drainage in 107 patients (91%). Transcutaneous localization of the SLN was possible in 104 patients (89%). In three patients, all of whom had no drainage demonstrated on lymphoscintigraphy, no SLN was identified at surgery (97.5% success rate for SLN identification). A mean of 2.3 SLNs per patient were identified. Twenty-five patients (21%) had at least one histologically positive SLN. In 23 of these patients, the positive SLN was the SLN with the most radioactivity, and in the remaining two patients, the positive SLN was both blue-stained and hot.
Day-before-surgery injection of high-dose 99mTc-labeled sulfur colloid results in high rates of transcutaneous and intraoperative identification of SLNs. The delay between injection and surgery did not appear to promote significant passage of sulfur colloid to second-echelon nodes.
在乳腺癌前哨淋巴结（SLN）活检中，许多中心采用术前当日注射99mTc标记的硫胶体以及术中注射蓝色染料来定位SLN。当日注射硫胶体可能存在问题，因为硫胶体迁移时间存在差异，这可能导致手术室时间利用效率低下，以及SLN与背景放射性比值较低。我们研究了术前一日注射高剂量99mTc标记硫胶体的效用。
手术前一日，在肿瘤周围注射高剂量99mTc标记的硫胶体，并进行淋巴闪烁显像。术中，注射蓝色染料后，使用γ探测器定位SLN。染成蓝色或放射性高的淋巴结被视为SLN并予以切除。
淋巴闪烁显像显示107例患者（91%）有引流。104例患者（89%）可经皮定位SLN。3例患者淋巴闪烁显像均未显示引流，手术中未发现SLN（SLN识别成功率为97.5%）。平均每位患者识别出2.3个SLN。25例患者（21%）至少有一个组织学阳性的SLN。在其中23例患者中，阳性SLN是放射性最强的SLN，在其余2例患者中，阳性SLN既被染成蓝色又放射性高。
术前一日注射高剂量99mTc标记的硫胶体可实现较高的经皮和术中SLN识别率。注射与手术之间的延迟似乎并未促使硫胶体大量转移至二级淋巴结。
