Anan Keisei, Mitsuyama Shoshu, Kuga Hirotaka, Saimura Michiyo, Tanabe Yoshitaka, Suehara Nobuhiro, Matsunaga Hiroaki, Nishihara Kazuyoshi, Abe Yuji, Iwashita Toshimitsu, Ihara Takaaki, Tamae Keiyoshi, Ono Minoru, Toyoshima Satoshi
Department of Surgery, Kitakyushu Municipal Medical Center Fukuoka, Japan.
Surgery. 2006 May;139(5):624-9. doi: 10.1016/j.surg.2005.11.007.
The optimum sentinel node biopsy (SNB) mapping method for breast cancer remains to be determined. No matter which mapping agents are used, 2-site injection may be superior to 1-site injection in limiting the false-negative rate.
We examined whether a double-mapping method with subareolar injection of blue dye and peritumoral injection of green dye would decrease the false-negative rate of dye-only SNB in 145 patients with early breast cancer.
The identification rate for blue-dyed and/or green-dyed (including mixed color-dyed) lymph nodes was 96.6% (140/145). Sensitivity and specificity were 95.1% (39/41) and 100% (99 of 99), respectively. Accuracy was 98.6% (138/140) with a false-negative rate of 4.9% (2/41). There were 4 patients in whom nodes of each color were found, but nodes of only 1 color were shown to be positive. The primary tumors of these 4 patients and of the 2 patients with false-negative results were located in the upper-outer quadrant of the breast. When only blue-dyed or green-dyed nodes (including mixed color-dyed nodes) were counted, the false-negative rates were 10.3% (4/39) for the subareolar mapping technique and 10.0% (4/40) for the peritumoral mapping technique.
The double-mapping method based on subareolar and peritumoral injections decreases the false-negative rate of dye-only SNB for early breast cancer. Variations in lymphatic channels may exist in the lateral half of the breast and thus may influence identification of positive sentinel nodes. This finding should be taken into account in cases of multicentric breast cancer.
乳腺癌前哨淋巴结活检（SNB）的最佳定位方法仍有待确定。无论使用哪种定位剂，在限制假阴性率方面，两点注射可能优于单点注射。
我们研究了在145例早期乳腺癌患者中，采用乳晕下注射蓝色染料和瘤周注射绿色染料的双重定位方法是否会降低单纯染料法SNB的假阴性率。
蓝色染料和/或绿色染料（包括混合染色）标记淋巴结的识别率为96.6%（140/145）。灵敏度和特异性分别为95.1%（39/41）和100%（99/99）。准确率为98.6%（138/140），假阴性率为4.9%（2/41）。有4例患者发现了每种颜色的淋巴结，但仅1种颜色的淋巴结显示为阳性。这4例患者以及2例假阴性结果患者的原发肿瘤均位于乳房的外上象限。当仅计算蓝色染料或绿色染料标记的淋巴结（包括混合染色的淋巴结）时，乳晕下定位技术的假阴性率为10.3%（4/39），瘤周定位技术的假阴性率为10.0%（4/40）。
基于乳晕下和瘤周注射的双重定位方法可降低早期乳腺癌单纯染料法SNB的假阴性率。乳房外侧半部可能存在淋巴管变异，从而可能影响前哨淋巴结阳性的识别。在多中心乳腺癌病例中应考虑这一发现。
