Shimazu Kenzo, Tamaki Yasuhiro, Taguchi Tetsuya, Takamura Yuuki, Noguchi Shinzaburo
Department of Surgical Oncology, Osaka University Medical School, Osaka, Japan.
Surgery. 2002 Mar;131(3):277-86. doi: 10.1067/msy.2002.121378.
The technique of sentinel lymph node (SLN) biopsy in patients with breast cancer varies among reports, and the optimal method remains to be established, particularly with regard to the site of radiotracer injection. The aim of this study was to compare periareolar and peritumoral injection of radiotracer in detecting SLN in patients with breast cancer.
Patients with T1-2 breast cancer (n = 155) were enrolled in this study. In phase 1 (n = 62), SLN biopsy was performed by using peritumoral injection of blue dye alone followed by backup axillary lymph node dissection. In phase 2, SLN biopsy was performed by using peritumoral injection of blue dye and peritumoral (group A, n = 41) or periareolar (group B, n = 52) injection of technetium 99m tin colloid.
In phase 1, the detection rate of SLN was 81% and the false-negative rate was 5.6%, indicating our skill in SLN biopsy. In phase 2, the success rate of lymphoscintigraphy was significantly (P <.001) higher in group B (90%) than in group A (51%). The mean ex vivo radioactivity of SLN in group B (117 counts per second; range, 5 to 900) was also significantly (P <.05) higher than in group A (51 counts per second; range, 8 to 260). In addition, the detection rate of SLN was significantly (P <.05) higher in group B (100%) than in group A (90%).
Periareolar injection of radiotracer for SLN biopsy is superior to peritumoral injection because of its simplicity, achieving a high success rate in lymphoscintigraphy and SLN detection.
乳腺癌患者前哨淋巴结（SLN）活检技术在不同报道中存在差异，最佳方法仍有待确定，尤其是放射性示踪剂的注射部位。本研究旨在比较乳晕周围和肿瘤周围注射放射性示踪剂在检测乳腺癌患者SLN中的效果。
本研究纳入了155例T1-2期乳腺癌患者。在第1阶段（n = 62），仅通过肿瘤周围注射蓝色染料进行SLN活检，随后进行腋窝淋巴结清扫作为备用。在第2阶段，通过肿瘤周围注射蓝色染料以及肿瘤周围（A组，n = 41）或乳晕周围（B组，n = 52）注射99m锝锡胶体进行SLN活检。
在第1阶段，SLN的检出率为81%，假阴性率为5.6%，表明我们在SLN活检方面的技术水平。在第2阶段，B组（90%）的淋巴闪烁显像成功率显著高于A组（51%）（P <.001）。B组SLN的平均体外放射性（每秒117计数；范围为5至900）也显著高于A组（每秒51计数；范围为8至260）（P <.05）。此外，B组（100%）的SLN检出率显著高于A组（90%）（P <.05）。
乳晕周围注射放射性示踪剂进行SLN活检优于肿瘤周围注射，因为其操作简单，在淋巴闪烁显像和SLN检测中成功率高。
