Gommans G M M, van der Zant F M, van der Schors T G, van Dongen A, Teule G J J, Clarijs W W J, Langenhorst B L A M, de Waard J W D
Department of Nuclear Medicine, Westfries Gasthuis Hoorn, 1620 AR Hoorn, The Netherlands.
Eur J Nucl Med Mol Imaging. 2003 Sep;30(9):1231-5. doi: 10.1007/s00259-003-1227-9. Epub 2003 Jun 25.
The aim of this study was to evaluate the count rates of sentinel lymph nodes (SLNs) in patients with breast cancer in the operating theatre, using (99m)Tc-Nanocoll with different ratios of technetium-99m to technetium-99. After written informed consent had been obtained, we tested different ratios of (99m)Tc/(99)Tc-Nanocoll in a double-blinded randomised study performed in 161 patients. Twenty-five MBq/ microg (99m)Tc-colloid albumin was prepared in vacuum. In 87 patients (group A) a 2-h elution was used and in 74 patients (group B) a 24-h elution was used. Patients were subcategorised into subgroups 1 and 3, in which an SLN procedure for breast carcinoma was performed simultaneously with lumpectomy, and subgroups 2 and 4, in which an SLN procedure was performed 2-3 weeks after prior excision biopsy. All patients were injected along the lateral border of the areola (two injections: 50 MBq/0.3 ml intradermally and 50 MBq/2 ml intraparenchymally). Ex vivo measurement of count rates was performed with a gamma probe. Comparing groups A and B in respect of registered counts per second (cps) of excised SLNs, a significant difference was found ( P<0.004). When comparisons were made between subgroups 1 and 2 (2-h elution) and between subgroups 3 and 4 (24-h elution) in respect of registered cps of excised SLNs, no significant difference was found (subgroup 1 vs 2, P=0.825; subgroup 3 vs 4, P=0.915). Use of a 2-h elution in vacuum yielded a significantly higher count rate of maximum specific activity of (99m)Tc-colloid albumin in SLNs than was achieved using a 24-h elution in vacuum. SLN procedures performed 2-3 weeks after prior excision biopsy proved reliable as compared to SLN procedures performed simultaneously with lumpectomy.
本研究的目的是在手术室中评估乳腺癌患者前哨淋巴结（SLN）的计数率，使用锝-99m与锝-99比例不同的（99m）Tc-纳米胶体。在获得书面知情同意后，我们在161例患者中进行了一项双盲随机研究，测试了不同比例的（99m）Tc/（99）Tc-纳米胶体。在真空中制备25MBq/μg的（99m）Tc-胶体白蛋白。87例患者（A组）采用2小时洗脱，74例患者（B组）采用24小时洗脱。患者被分为1组和3组，其中乳腺癌的SLN手术与肿块切除术同时进行，以及2组和4组，其中SLN手术在先前切除活检后2至3周进行。所有患者均沿乳晕外侧边缘注射（两次注射：皮内注射50MBq/0.3ml和实质内注射50MBq/2ml）。使用γ探头进行切除的SLN的计数率离体测量。比较A组和B组切除的SLN每秒计数（cps），发现有显著差异（P<0.004）。当比较1组和2组（2小时洗脱）以及3组和4组（24小时洗脱）切除的SLN的记录cps时，未发现显著差异（1组与2组，P=0.825；3组与4组，P=0.915）。与在真空中使用24小时洗脱相比，在真空中使用2小时洗脱产生的SLN中（99m）Tc-胶体白蛋白的最大比活计数率显著更高。与与肿块切除术同时进行的SLN手术相比，先前切除活检后2至3周进行的SLN手术被证明是可靠的。
