Yoshida Kazuya, Yamamoto Naohito, Imanaka Nobuhiro, Togawa Takashi, Miyauchi Mitsuru, Miyazaki Masaru
Division of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-ku, Chiba City, Chiba 260-8717, Japan.
Breast Cancer. 2002;9(4):319-22. doi: 10.1007/BF02967611.
Controversy surrounds the correct injection site of radioisotope (RI) and blue dye for sentinel node biopsy (SNB) in breast cancer, and there have been some reports on the advantages of subareolar (SA) injection. We carried out a study to assess whether SA injection is useful for all patients undergoing SNB.
In this prospective study, 20 patients with T1 or T2 tumors clinically node negative, were enrolled. Injection of 99mTc-phytate (0.5 mCi) was performed two times (3 to 5 days before surgery and the day of surgery) for each patient. The first RI injection was SA, and the second RI injection was subdermal (SD). The location and number of hot nodes were assessed by lymphoscintigraphy (LSG) and hand-held gamma probe.
There were no patients in whom hot nodes on LSG were visualized in clearly different locations between the SA and SD injection sites. However, there were 2 patients in whom hot nodes were identified at different locations with a gamma probe. Seven patients had more hot nodes on LSG with SD injection than SA injection. Eight patients had a higher RI count of hot nodes by SD injection than SA injection. The mean RI count of hot nodes by SA injection was higher than that after SD injection.
SA and SD lymphatic flow run into the same node in most patients, however, SD injection is more useful than SA injection in some patients. Though SA injection is a useful technique, it may not identify sentinel lymph nodes correctly in patients with multiple lesions or tumors in the upper outer quadrant.
乳腺癌前哨淋巴结活检（SNB）中放射性同位素（RI）和蓝色染料的正确注射部位存在争议，已有一些关于乳晕下（SA）注射优势的报道。我们开展了一项研究，以评估SA注射对所有接受SNB的患者是否有用。
在这项前瞻性研究中，纳入了20例临床淋巴结阴性的T1或T2肿瘤患者。每位患者进行两次99mTc-植酸盐（0.5 mCi）注射（手术前3至5天和手术当天）。首次RI注射为SA注射，第二次RI注射为皮下（SD）注射。通过淋巴闪烁显像（LSG）和手持式γ探针评估热结节的位置和数量。
在LSG上，没有患者的热结节在SA和SD注射部位之间的位置有明显差异。然而，有2例患者通过γ探针在不同位置发现了热结节。7例患者SD注射后LSG上的热结节比SA注射后多。8例患者SD注射后的热结节RI计数高于SA注射后。SA注射的热结节平均RI计数高于SD注射后。
在大多数患者中，SA和SD淋巴引流汇入同一淋巴结，然而，在一些患者中，SD注射比SA注射更有用。虽然SA注射是一种有用的技术，但对于上外象限有多个病灶或肿瘤的患者，可能无法正确识别前哨淋巴结。
