Masiero Paulo R, Xavier Nilton L, Spiro Bernardo L, Detanico Maria F, Xavier Miguel da C, Pinto Ana L A
Department of Nuclear Medicine, Universidade Federal do rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Nucl Med Commun. 2005 Dec;26(12):1087-91. doi: 10.1097/00006231-200512000-00007.
Breast cancer surgery has evolved towards minimizing morbidity, maximizing cure rates and stratifying treatments according to disease stage. Sentinel lymph node biopsy is becoming standard practice in most centres. However, no standard radiopharmaceutical exists.
To blindly compare 99mTc dextran 500 and 99mTc phytate in the scintigraphic detection of sentinel lymph nodes. Endpoints were the detection of axillary or internal mammary lymph nodes, number of lymph nodes detected, detectability in the first versus the second hour of evaluation and the relationship between rate of detection and age or body mass index.
Forty-six patients with histological diagnosis of early breast cancer, without previous surgical treatment, were enrolled in our study. Each patient underwent lymphoscintigraphy twice: on one day with 99mTc dextran 500 and on another day with 99mTc phytate. Images were acquired 1 h and 2 h after tracer administration.
Eighty-eight lymphoscintigraphic studies were performed in 44 patients. On the first image (taken at 1 h), 34 patients from the 99mTc dextran group showed sentinel nodes compared with 28 positive examinations using 99mTc phytate (P = 0.113). On the second image (taken at 2 h) 39 patients from the 99mTc dextran group showed positive results compared to 30 positive examinations using 99mTc phytate (P = 0.036). There was no statistically significant correlation between the body mass index or age and the result of the lymphoscintigraphy.
99mTc dextran 500 is better than 99mTc phytate for use in a 2 h interval scintigraphic protocol because it demonstrates the sentinel node in a significantly higher number of patients and also showed more lymph nodes suitable for pathological examination.
乳腺癌手术已朝着降低发病率、提高治愈率以及根据疾病阶段分层治疗的方向发展。前哨淋巴结活检在大多数中心正成为标准做法。然而，目前尚无标准的放射性药物。
在闪烁显像检测前哨淋巴结方面，对99mTc葡聚糖500和99mTc植酸盐进行盲法比较。观察指标包括腋窝或内乳淋巴结的检测情况、检测到的淋巴结数量、评估第1小时与第2小时的可检测性以及检测率与年龄或体重指数之间的关系。
46例经组织学诊断为早期乳腺癌且未接受过手术治疗的患者纳入本研究。每位患者均接受两次淋巴闪烁显像：一天使用99mTc葡聚糖500，另一天使用99mTc植酸盐。在注射示踪剂后1小时和2小时采集图像。
44例患者共进行了88次淋巴闪烁显像研究。在第一张图像（1小时时拍摄）上，99mTc葡聚糖组有34例患者显示前哨淋巴结，而99mTc植酸盐组有28例检查呈阳性（P = 0.113）。在第二张图像（2小时时拍摄）上，99mTc葡聚糖组有39例患者结果为阳性，而99mTc植酸盐组有30例检查呈阳性（P = 0.036）。体重指数或年龄与淋巴闪烁显像结果之间无统计学显著相关性。
在2小时间隔闪烁显像方案中，99mTc葡聚糖500比99mTc植酸盐更具优势，因为它能在显著更多的患者中显示前哨淋巴结，并且显示出更多适合病理检查的淋巴结。
