Jastrzebski Tomasz, Kopacz Andrzej, Lass Piotr
Department of Surgical Oncology, Medical University of Gdańsk, Poland.
Nucl Med Rev Cent East Eur. 2002;5(2):159-61.
The new trend in diagnosis of the lymph node is sentinel node biopsy. This method has become increasingly accepted as a minimally invasive alternative to routine axillary dissection. Although the results of numerous studies have shown that sentinel node biopsy can accurately determine the axillary nodal status, the identification rates and false-negative rates have been variable. The sentinel lymph node is defined as the first node in the lymphatic basin that receives the primary lymphatic flow.
Between September 1998 and August 2002 123 patients with primary operative breast cancer without clinical palpable axillary lymph nodes were enrolled in the study. There were two groups of patients according to sentinel node identification technique: 51 patients (Group I) received parenchymal, peritumoral injection of 1.0 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour. The next 72 patients (Group II) received intradermal, periareolar one-site injection of 0.5 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and blue-dye.
Sentinel lymph node was found in 41 (80.4%) cases in Group I and in 67 (93.0%) cases in Group II (p = 0.028). The localisation of the axillary lymph node as a "hot spot" visualised by lymphoscintigraphy was successful in 39/51 (76.5%) cases in Group I and 67/72 (93.0%) in Group II, p = 0.004). In both groups the success of sentinel node identification in the axillary region by lymphoscintigraphy was connected with sentinel lymph node finding during surgery (Group I: p < 0.001, Group II: p < 0.001).
This study shows that intradermal, periareolar one-site injection of Tc(99m)-radiolabelled sulphur colloid and blue-dye is superior to peritumoral 4-sites injections Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour in sentinel lymph node identification.
淋巴结诊断的新趋势是前哨淋巴结活检。这种方法作为常规腋窝清扫术的微创替代方法已越来越被接受。尽管众多研究结果表明前哨淋巴结活检能够准确确定腋窝淋巴结状态，但识别率和假阴性率一直存在差异。前哨淋巴结被定义为淋巴引流区域中接收主要淋巴液流的第一个淋巴结。
1998年9月至2002年8月期间，123例原发性乳腺癌且临床未触及腋窝淋巴结的患者纳入本研究。根据前哨淋巴结识别技术将患者分为两组：51例患者（第一组）在肿瘤实质、瘤周注射1.0 ml 16 MBq锝（99m）标记的硫胶体，并在肿瘤上方进行单次皮内注射蓝色染料。接下来的72例患者（第二组）在乳晕周围皮内进行单点注射0.5 ml 16 MBq锝（99m）标记的硫胶体和蓝色染料。
第一组41例（80.4%）发现前哨淋巴结，第二组67例（93.0%）发现前哨淋巴结（p = 0.028）。通过淋巴闪烁显像将腋窝淋巴结定位为“热点”，第一组39/51例（76.5%）成功，第二组67/72例（93.0%）成功，p = 0.004）。两组中通过淋巴闪烁显像在腋窝区域识别前哨淋巴结的成功率与手术中发现前哨淋巴结相关（第一组：p < 0.001，第二组：p < 0.001）。
本研究表明，在乳晕周围皮内单点注射锝（99m）标记的硫胶体和蓝色染料在前哨淋巴结识别方面优于在肿瘤周围四点注射锝（99m）标记的硫胶体并在肿瘤上方进行单次皮内注射蓝色染料。
