Aarsvold John N, Alazraki Naomi P
Veterans Affairs Medical Center and Emory University, Atlanta, GA 30033, USA.
Semin Nucl Med. 2005 Apr;35(2):116-28. doi: 10.1053/j.semnuclmed.2004.11.003.
Sentinel lymph node biopsy is now the practice of choice for the management of many patients with breast cancer. This was not true in the early 1990s, when the first such procedures were performed and protocols for such were refined often. This was also not true in the first years of the 21st century, when a decade of collective experience and information acquired from numerous clinical investigations dictated additional subtle and not-so-subtle refinements of the procedures. However, it is true today; reports of the latest round of clinical investigations indicate that there are several breast cancer sentinel node procedures that result in successful identification of potential sentinel nodes in nearly all patients who are eligible for such procedures. A significant component of many of these successful sentinel node procedures is a detection and localization protocol that involves radiotracer methodologies, including radiopharmaceutical administration, preoperative nuclear medicine imaging, and intraoperative gamma counting. The present state and roles of nuclear medicine protocols used in breast cancer sentinel lymph node biopsy procedures is reviewed with emphasis on discussion of recent results, unresolved issues, and future considerations. Included are brief reviews of present radiotracer and blue-dye techniques for node localization, including remarks about injection strategies, counting probe technology, and radiation safety. Included also are discussions of on-going investigations of the implications of the presence of micrometastases; of the management value of detection, localization, and excision of extra-axillary nodes such as internal mammary nodes; and of the broad range of recurrence rates presently being reported. Remarks on the present and possible near- and long-term roles for nuclear medicine in the staging of breast cancer patients including comments on positron emission tomography and intraoperative imaging conclude the article.
前哨淋巴结活检现已成为许多乳腺癌患者治疗的首选方法。在20世纪90年代初并非如此，当时首次开展此类手术，相关方案也经常得到完善。在21世纪的头几年同样并非如此，当时从众多临床研究中积累了十年的经验和信息，促使对这些手术进行了更多细微和不那么细微的改进。然而，如今情况确实如此；最新一轮临床研究报告表明，有几种乳腺癌前哨淋巴结手术几乎能在所有符合条件的患者中成功识别潜在的前哨淋巴结。许多这些成功的前哨淋巴结手术的一个重要组成部分是检测和定位方案，该方案涉及放射性示踪剂方法，包括放射性药物给药、术前核医学成像和术中γ计数。本文回顾了乳腺癌前哨淋巴结活检手术中使用的核医学方案的现状和作用，重点讨论了近期结果、未解决的问题以及未来的考虑因素。其中包括对目前用于淋巴结定位的放射性示踪剂和蓝色染料技术的简要回顾，包括关于注射策略、计数探头技术和辐射安全的说明。还讨论了正在进行的关于微转移存在的影响的研究；关于检测、定位和切除腋窝外淋巴结（如内乳淋巴结）的管理价值的研究；以及目前报道的广泛复发率的研究。文章最后对核医学在乳腺癌患者分期中的当前和可能的近期及长期作用进行了评论，包括对正电子发射断层扫描和术中成像的评论。
