Motomura Kazuyoshi, Komoike Yoshifumi, Hasegawa Yoshihisa, Kasugai Tsutomu, Inaji Hideo, Noguchi Shinzaburo, Koyama Hiroki
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
J Surg Oncol. 2003 Feb;82(2):91-6; discussion 96-7. doi: 10.1002/jso.10200.
The purpose of the present study was to evaluate whether the intradermal injection of radiocolloids would improve the identification rate of sentinel nodes over the subdermal injection in breast cancer patients.
Sentinel node biopsy was performed in T2 breast cancer patients with clinically negative nodes, using subdermal or intradermal injection of radioisotopes with the peritumoral dye injection. We used Tc-99m tin colloid, with a larger particle size (0.4-5 microm), rather than sulfur colloid and colloidal albumin.
The initial 55 patients underwent subdermal injection of radiocolloids; the next 61 patients underwent intradermal injection of radiocolloids for sentinel node biopsy. The detection rate of sentinel nodes was significantly (P = 0.048) higher in the intradermal injection group (61/61, 100%) than in the subdermal injection group (51/55, 92.7%). False-negative rates were comparable between the two groups. Lymphoscintigraphy visualized the sentinel nodes significantly (P < 0.0001) more often in the intradermal injection group (59/61, 96.7%) than in the subdermal injection group (20/54, 37.0%).
A significantly higher identification rate of sentinel node biopsy and lymphoscintigraphy can be achieved by intradermal injection of Tc-99m tin colloid with a large particle size than by subdermal injection.
本研究旨在评估在乳腺癌患者中，皮内注射放射性胶体是否比皮下注射能提高前哨淋巴结的识别率。
对临床腋窝淋巴结阴性的T2期乳腺癌患者进行前哨淋巴结活检，采用皮下或皮内注射放射性同位素并联合瘤周染料注射。我们使用的是粒径较大（0.4 - 5微米）的锝-99m锡胶体，而非硫胶体和胶体白蛋白。
最初的55例患者接受了放射性胶体的皮下注射；接下来的61例患者接受了放射性胶体的皮内注射以进行前哨淋巴结活检。皮内注射组前哨淋巴结的检出率（61/61，100%）显著高于皮下注射组（51/55，92.7%）（P = 0.048）。两组的假阴性率相当。淋巴闪烁显像显示皮内注射组（59/61，96.7%）前哨淋巴结显影的次数显著多于皮下注射组（20/54，37.0%）（P < 0.0001）。
与皮下注射相比，皮内注射粒径较大的锝-99m锡胶体可显著提高前哨淋巴结活检和淋巴闪烁显像的识别率。
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