van Wessem K J P, Meijer W S
Department of General Surgery, Medical Centre Rijnmond-Zuid, location Clara, Olympiaweg 350, NL-3078 HT Rotterdam, The Netherlands.
Breast. 2004 Aug;13(4):290-6. doi: 10.1016/j.breast.2004.03.002.
Several methods are in use for identification of the sentinel lymph node (SLN) in breast cancer. We set up the hypothesis that intradermal (i.d.) infra-areolar injection of technetium-99m in combination with i.d. injection of patent blue dye lateral to the areola can identify the same lymph node as peritumoral injection, regardless of the location of the tumour. Each of 50 patients with breast cancer (group I) received an i.d. injection of technetium-99m 1cm caudal to the areola. After induction, blue dye was injected intradermally 1cm lateral to the areola. These patients underwent axillary dissection regardless of their lymph node status. The SLN was identified in 96% of these patients. One of them had axillary lymph node metastases even though the SLN was negative (6%). Further 82 patients (group II) underwent SLN identification and removal without further axillary dissection. The duration of mean follow-up for these patients was 28 months (16-39 months). One patient developed axillary recurrence (1%) 24 months after the initial operation. Intradermal periareolar tracer injection is an accurate method of locating the sentinel node. Long-term follow-up of patients who had negative sentinel nodes and did not undergo axillary dissection revealed a low axillary recurrence rate.
目前有多种方法用于识别乳腺癌前哨淋巴结（SLN）。我们提出一个假设，即乳晕下皮内注射99m锝并联合乳晕外侧皮内注射专利蓝染料，无论肿瘤位置如何，都能与瘤周注射识别出同一淋巴结。50例乳腺癌患者（I组），均在乳晕尾侧1cm处皮内注射99m锝。诱导后，在乳晕外侧1cm处皮内注射蓝色染料。无论淋巴结状态如何，这些患者均接受腋窝淋巴结清扫术。其中96%的患者识别出了前哨淋巴结。其中1例患者尽管前哨淋巴结阴性，但仍有腋窝淋巴结转移（6%）。另外82例患者（II组）未进行进一步腋窝淋巴结清扫术，仅进行了前哨淋巴结识别和切除。这些患者的平均随访时间为28个月（16 - 39个月）。1例患者在初次手术后24个月出现腋窝复发（1%）。乳晕周围皮内注射示踪剂是一种准确的定位前哨淋巴结的方法。对前哨淋巴结阴性且未进行腋窝淋巴结清扫术的患者进行长期随访，发现腋窝复发率较低。
