Ruano R, Ramos M, Garcia-Talavera J R, Serrano E, De Arriba A, Gonzalez-Orus J, Iglesias M, Macias M C
Nuclear Medicine, University Hospital of Salamanca, Salamanca, Spain.
Eur J Nucl Med Mol Imaging. 2008 Jul;35(7):1299-304. doi: 10.1007/s00259-008-0730-4. Epub 2008 Feb 12.
To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer.
In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ((99m)Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located.
Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla.
The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue.
介绍我们对先前已行乳腺癌切除的患者进行前哨淋巴结活检（SNB）的治疗经验，将患者分为不可触及和可触及病变两组，并与乳腺癌的治疗时间和分期进行比较。
在2001年至2006年期间，对138例先前已行诊断性切除活检的患者（96例不可触及乳腺癌和42例可触及乳腺癌）以及328例未行过手术的患者（32例不可触及癌；296例可触及癌）进行了治疗。联合技术（（99m）锝 - 硫化铼胶体和异硫蓝染料）用于前哨淋巴结（SLN）检测。仅当前哨淋巴结转移阳性或未找到时才完成腋窝淋巴结清扫（ALND）。
如果先前已行手术，不可触及癌的检测率为95%，可触及癌为98%，一次性治疗组为99%。不可触及癌的前哨淋巴结转移率为15%（14/91），明显低于可触及乳腺癌（先前手术组为39%，一次性手术组为37%）。根据肿瘤大小，T1和T2肿瘤的腋窝淋巴结清扫转移率相似（43 - 44%）。在对先前已行乳腺癌诊断性活检或手术的组进行随访时，我们在腋窝未发现任何假阴性。
对先前已行乳腺癌手术的患者进行前哨淋巴结检测也是可行的。由于不可触及病变的前哨淋巴结转移率明显较低，乳腺癌早期检测筛查计划以及通过超声或立体定向引导的核心活检改善恶性肿瘤组织病理学确认的工作必须继续。
