Sardi Armando, Spiegler Ethan, Colandrea Jean, Frishberg David, Sing Hardeep, Regan Patricia, Totoonchie Adil, Merchant Deepak, Hochuli Stephen, Setya Viney, Singer John A
Department of Surgery, St. Agnes Hospital, Baltimore, Maryland 21229, USA.
Am Surg. 2002 Jan;68(1):24-8.
Sentinel lymph node (SLN) mapping has revolutionized the way we stage breast cancer. A blue dye technique (BD) and the use of a radiotracer with the assistance of a gamma-detecting probe (GDP) have been used for the identification of the sentinel nodes. Some groups have suggested that only one technique is necessary. The reported false negative rates have been 0 to 12 per cent and success rates as low as 65 per cent. We have prospectively evaluated these techniques and have used both for the identification of the SLN. Ten surgeons participated in this study. From April 1998 through May 1999, 58 patients underwent SLN mapping followed by an axillary lymph node dissection. After the injection of 0.3 to 1.96 mCi of filtered sulfur colloid diluted to 4 mL all patients had preoperative lymphoscintigraphy. Five minutes before surgery 3 to 5 mL of isosulfan blue was injected around the tumor or tumor bed. Even though preoperative lymphoscintigraphy identified an SLN in 35 patients (63%) successful intraoperative detection of an SLN was possible using both techniques in 53 patients (91%). The SLN was detected by the BD and the GDP in 37 (65%) and 45 (80%) respectively. Nineteen patients (33%) were positive for metastatic disease in the axilla. Twenty-two (19%) of 113 SLNs removed were positive for disease. All cases of metastatic disease in the axilla were detected by the mapping technique. False negative rate was 0 per cent. In 11 patients the only positive node was the sentinel node (58%). Furthermore six (32%) patients were upstaged by the use of immunostains for cytokeratin. Twenty-two positive SLNs were detected in the 19 patients. The positive lymph node was identified only by BD in four patients (21%), only by GDP in six patients (31%), and by both techniques in nine patients (47%). We conclude that if only one technique had been used the false negative rate could have been as high as 32 per cent. Both techniques must be used to obtain a low false negative rate and high yield in the identification of the SLN.
前哨淋巴结（SLN）定位彻底改变了我们对乳腺癌进行分期的方式。一种蓝色染料技术（BD）以及在γ探测仪（GDP）辅助下使用放射性示踪剂已被用于识别前哨淋巴结。一些研究团队认为仅使用一种技术就足够了。报道的假阴性率为0%至12%，成功率低至65%。我们前瞻性地评估了这些技术，并同时使用这两种技术来识别前哨淋巴结。十位外科医生参与了这项研究。从1998年4月至1999年5月，58例患者接受了前哨淋巴结定位，随后进行腋窝淋巴结清扫术。在注射0.3至1.96毫居里过滤后的硫胶体并稀释至4毫升后，所有患者均进行了术前淋巴闪烁显像。手术前5分钟，在肿瘤或肿瘤床周围注射3至5毫升异硫蓝。尽管术前淋巴闪烁显像在35例患者（63%）中识别出了前哨淋巴结，但术中使用这两种技术在53例患者（91%）中成功检测到了前哨淋巴结。通过蓝色染料技术和γ探测仪分别检测到前哨淋巴结的患者有37例（65%）和45例（80%）。19例患者（33%）腋窝有转移性疾病阳性。切除的113个前哨淋巴结中有22个（19%）有疾病阳性。腋窝所有转移性疾病病例均通过定位技术检测到。假阴性率为0%。在11例患者中，唯一的阳性淋巴结是前哨淋巴结（58%）。此外，6例（32%）患者通过细胞角蛋白免疫染色进行了分期上调。在19例患者中检测到22个阳性前哨淋巴结。仅通过蓝色染料技术在4例患者（21%）中识别出阳性淋巴结，仅通过γ探测仪在6例患者（31%）中识别出阳性淋巴结，通过两种技术在9例患者（47%）中识别出阳性淋巴结。我们得出结论，如果仅使用一种技术，假阴性率可能高达32%。必须同时使用这两种技术，才能在前哨淋巴结识别中获得低假阴性率和高检出率。
