Maza Sofiane, Thomas Anke, Winzer Klaus J, Hüttner Christine, Blohmer Jens-Uwe, Hauschild Maik, Richter Matthias, Krössin Thomas, Geworski Lilli, Zander Andreas, Guski Hans, Munz Dieter L
Clinic for Nuclear Medicine, Charité-University Medicine Berlin, Schumannstrasse 20-21, 10117 Berlin, Germany.
Eur J Nucl Med Mol Imaging. 2004 May;31(5):671-5. doi: 10.1007/s00259-003-1447-z. Epub 2004 Jan 27.
According to recently published guidelines, histological clarification by interventional techniques should be undertaken before planning the surgical management of patients with breast carcinoma. In patients with previous manipulations on the primary tumour, peritumoural injection in the context of preoperative scintigraphic detection of the sentinel lymph nodes is not possible. The aim of this prospective study was to clarify whether subareolar injection of nanocolloid can yield reliable data on the axillary lymph node tumour status in breast cancer patients with previous manipulations on the primary tumour. To date, 117 women (age 31-80 years) with breast carcinoma have been enrolled. All of these patients had undergone a biopsy (n=88) or surgery on the primary tumour (n=29) and were without clinical suspicion of lymph node metastases. Subareolar injection of 40 MBq technetium-99m nanocolloid was carried out in at least eight deposits around the areolar margin [one deposit in the middle of each quadrant and one deposit at each quadrant intersection (0.05 ml/deposit)]. Immediately after injection, dynamic and static lymphoscintigraphy of the axillary, thoracic and cervical areas was performed in various views with a gamma camera (LEAP collimator, 256x256 matrix). Lymphatic drainage was directed exclusively to the ipsilateral axilla. Sentinel lymph node biopsy and elective dissection of axillary lymph nodes were performed in all patients. All lymph nodes removed were examined by histology and immunohistochemistry. In 26 patients, lymph node metastases were found in the sentinel lymph nodes. In six of them, non-sentinel lymph nodes also showed tumour involvement. In the remaining 91 patients, lymph node metastases could be found neither in sentinel lymph nodes nor in non-sentinel lymph nodes. In conclusion, subareolar nanocolloid injection can yield reliable information on the axillary lymph node tumour status in patients with previous manipulations on the primary tumour in the breast.
根据最近发布的指南，在规划乳腺癌患者的手术治疗之前，应采用介入技术进行组织学明确诊断。对于先前对原发性肿瘤进行过操作的患者，在术前通过闪烁显像检测前哨淋巴结时进行肿瘤周围注射是不可能的。这项前瞻性研究的目的是明确乳晕下注射纳米胶体是否能为先前对原发性肿瘤进行过操作的乳腺癌患者的腋窝淋巴结肿瘤状态提供可靠数据。迄今为止，已有117名年龄在31至80岁之间的乳腺癌女性患者入组。所有这些患者均对原发性肿瘤进行过活检（n = 88）或手术（n = 29），且临床上均无淋巴结转移的怀疑。在乳晕边缘周围至少八个部位注射40 MBq的锝-99m纳米胶体[每个象限中间一个部位，每个象限交点处一个部位（0.05 ml/部位）]。注射后立即使用γ相机（LEAP准直器，256×256矩阵）在不同视角对腋窝、胸部和颈部区域进行动态和静态淋巴闪烁显像。淋巴引流仅导向同侧腋窝。所有患者均进行了前哨淋巴结活检和腋窝淋巴结选择性清扫。对所有切除的淋巴结进行了组织学和免疫组织化学检查。在26例患者中，前哨淋巴结发现有淋巴结转移。其中6例患者的非前哨淋巴结也有肿瘤累及。在其余91例患者中，前哨淋巴结和非前哨淋巴结均未发现淋巴结转移。总之，乳晕下纳米胶体注射可为先前对乳腺原发性肿瘤进行过操作的患者的腋窝淋巴结肿瘤状态提供可靠信息。
