Leidenius Marjut Hannele Kristiina, Krogerus Leena Anneli, Toivonen Terttu Sinikka, Leppänen Esa Antero, von Smitten Karl Albert Johan
Breast Surgery Unit, Helsinki University Hospital, FIN-00029 HUS, Helsinki, P.O. Box 140, Finland.
Ann Surg Oncol. 2006 Mar;13(3):321-6. doi: 10.1245/ASO.2006.02.022. Epub 2006 Jan 30.
Lymphoscintigraphy (LS) with sentinel node (SN) biopsy is proposed to provide a feasible method to complete lymphatic staging in breast cancer. The aim of this study was to evaluate the clinical value of parasternal SN biopsy.
A total of 984 consecutive patients with clinical stage T1/2N0 invasive breast cancer who underwent LS and SN biopsy were included in the study. A prospectively collected database was used. An intratumoral injection of 50 to 145 MBq of (99m)Tc-labeled human albumin colloid (Nanocoll) was used for preoperative LS.
LS showed the axillary SN in 844 (86%) cases and the parasternal SN in 138 (14%) cases. The median number of visualized parasternal SN was 2 (range, 1-6). Visualization of the parasternal SN was more common in patients with mediocentral tumors (81 of 399; 20%) and in patients with lateral tumors (56 of 585; 10%; P < .0001). Parasternal SNs were visualized more often, in 100 (17%) of 584 patients without axillary metastases compared with 38 (10%) of 400 patients with metastatic axillary nodes (P = .0006). Parasternal SNs were harvested successfully in 121 (88%) patients with visualization of those nodes. Parasternal SN metastases were detected in 18 patients, with a median of 1 metastasis (range, 1-4 metastases). Eight of these 18 patients were axillary node negative.
Parasternal SN biopsy results in upstaging in 2% of all breast cancer patients who undergo SN biopsy. The clinical value of the procedure seems insignificant, although it may influence the adjuvant treatment regimen in some patients.
前哨淋巴结活检的淋巴闪烁显像术（LS）被认为是一种可行的方法，可用于完成乳腺癌的淋巴分期。本研究旨在评估胸骨旁前哨淋巴结活检的临床价值。
本研究纳入了984例连续接受LS和前哨淋巴结活检的临床分期为T1/2N0的浸润性乳腺癌患者。使用前瞻性收集的数据库。术前LS采用瘤内注射50至145MBq的（99m）Tc标记的人白蛋白胶体（纳米胶体）。
LS在844例（86%）患者中显示腋窝前哨淋巴结，在138例（14%）患者中显示胸骨旁前哨淋巴结。可见胸骨旁前哨淋巴结的中位数为2个（范围为1至6个）。胸骨旁前哨淋巴结的显现在中央肿瘤患者（399例中的81例；20%）和外侧肿瘤患者（585例中的56例；10%；P <.0001）中更为常见。在584例无腋窝转移的患者中，100例（17%）的胸骨旁前哨淋巴结可见，而在400例有腋窝转移的患者中，38例（10%）可见，差异有统计学意义（P =.0006）。在121例（88%）可见胸骨旁前哨淋巴结的患者中成功获取了该淋巴结。在18例患者中检测到胸骨旁前哨淋巴结转移，转移灶中位数为1个（范围为1至4个）。这18例患者中有8例腋窝淋巴结阴性。
胸骨旁前哨淋巴结活检使2%接受前哨淋巴结活检的乳腺癌患者分期上调。该操作的临床价值似乎不大，尽管它可能会影响一些患者的辅助治疗方案。
