Eroglu A, Mudun A, Berberoglu K, Asoglu O, Ozmen V, Muslumanoglu M, Bozfakioglu Y, Yavuz E, Tuzlali S, Cantez S
Department of Nuclear Medicine, Istanbul University, School of Medicine, Capa, Turkey.
Clin Nucl Med. 2004 May;29(5):306-11. doi: 10.1097/01.rlu.0000122629.60728.a1.
The purpose of this study was to evaluate 2 different injection techniques for lymphoscintigraphy to determine the axillary sentinel lymph node (SLN) in patients with breast cancer.
Thirty-six patients with early breast cancer were studied prospectively. Both peritumoral (PT) and subdermal (SD) injections were performed on each patient with Tc-99m rhenium sulfide colloid. PT injections were done 1 to 8 days before surgery and SD injections were done on the day of operation. An intraoperative gamma probe was used to explore the axillary SLNs prior to tumor excision and axillary dissection. All surgical specimens were evaluated histopathologically.
In 19 of 36 patients, the same lymphatic drainage sites were observed with both techniques. Of these, 17 patients showed only axillary, 1 showed axillary and internal mammary (IM), and 1 showed axillary and subclavicular drainage sites. With PT injections 26 of 36 patients (72%), and with SD injections 33 of 36 patients (92%), showed axillary drainage and axillary SLNs. With PT injections 9 patients, and with SD injections only 2 patients, did not show any drainage site. During the operation with a gamma probe, axillary SLNs were excised in 35 patients (success rate, 97%). IM drainage was seen in 8 of 36 patients who underwent PT injections and in 3 of 36 with SD injections.
The success rate was found to be higher with the SD injection technique than with PT injections to visualize the axillary SLN. To increase the visualization of both axillary and IM SLNs, it may be useful to perform lymphoscintigraphy with SD and PT injections together.
本研究旨在评估两种不同的注射技术用于淋巴闪烁显像，以确定乳腺癌患者腋窝前哨淋巴结（SLN）。
对36例早期乳腺癌患者进行前瞻性研究。对每位患者分别进行瘤周（PT）和皮下（SD）注射99m锝硫化铼胶体。PT注射在手术前1至8天进行，SD注射在手术当天进行。在肿瘤切除和腋窝清扫前，使用术中γ探测仪探测腋窝SLN。所有手术标本均进行组织病理学评估。
36例患者中有19例，两种技术观察到相同的淋巴引流部位。其中，17例患者仅显示腋窝引流，1例显示腋窝和内乳（IM）引流，1例显示腋窝和锁骨下引流部位。PT注射的36例患者中有26例（72%），SD注射的36例患者中有33例（92%）显示腋窝引流和腋窝SLN。PT注射的患者中有9例，SD注射的患者中仅有2例未显示任何引流部位。在手术中使用γ探测仪时，35例患者切除了腋窝SLN（成功率97%）。接受PT注射的36例患者中有8例、接受SD注射的36例患者中有3例出现IM引流。
发现SD注射技术在可视化腋窝SLN方面的成功率高于PT注射技术。为了增加腋窝和IM SLN的可视化，同时进行SD和PT注射的淋巴闪烁显像可能是有用的。
