Takahashi Masako, Sasa Mitsunori, Hirose Chieko, Hisaoka Sonoka, Taki Masako, Hirose Toshiyuki, Bando Yoshimi
Department of Surgery, Tokushima Breast Care Clinic, 4-7-7, Nakashimada-Cho, Tokushima, 770-0052, Japan.
World J Surg Oncol. 2008 Jun 12;6:57. doi: 10.1186/1477-7819-6-57.
Combining a radioisotope with a dye-guided method is the best method for identification of the sentinel lymph nodes (SNs) in breast cancer. However, some institutions are limited to use of a dye-guided method alone. Recently, computed tomographic lymphography (CTLG) employing a nonionic contrast medium has achieved SN identification.
218 patients with primary breast cancer and no clinical evidence of lymph node metastasis were studied. SN identification was performed by CTLG and a dye-guided method. The SN identification rate was analyzed for correlations with the clinicopathological findings.
The SN identification rates were 96% with CTLG, 92% with the dye-guided method and 99% with both methods combined. The identification rates with CTLG and the combined method were significantly lower in node-positive patients compared to node-negative patients, and significantly lower with the combined method in vascular invasion-positive patients compared to negative patients. In addition, the SN identification rate with the dye-guided method was significantly lower in patients with a body mass index (BMI) of > or = 25, whereas the BMI did not affect the identification rate with CTLG or the combined method. Multiple SNs were detected in approximately 20% of the patients.
Combined performance of CTLG and a dye-guided method enables identification of SNs prior to breast cancer surgery. That SN identification is easier compared with by the dye-guided method alone, and the identification rate is improved compared with either method alone. The combination of methods was especially useful in obese patients. For patients with multiple SNs, the combination has the further advantage of enabling accurate SN biopsy. CTLG may yield false-negative findings in node-positive patients and patients with lymph vessel obstruction.
将放射性同位素与染料引导法相结合是识别乳腺癌前哨淋巴结（SNs）的最佳方法。然而，一些机构仅限于单独使用染料引导法。最近，采用非离子型造影剂的计算机断层淋巴造影（CTLG）已实现了SN的识别。
对218例原发性乳腺癌且无临床淋巴结转移证据的患者进行了研究。通过CTLG和染料引导法进行SN识别。分析SN识别率与临床病理结果的相关性。
CTLG的SN识别率为96%，染料引导法为92%，两种方法联合使用时为99%。与淋巴结阴性患者相比，淋巴结阳性患者使用CTLG和联合方法的识别率显著降低；与血管侵犯阴性患者相比，血管侵犯阳性患者使用联合方法的识别率显著降低。此外，体重指数（BMI）≥25的患者使用染料引导法的SN识别率显著降低，而BMI不影响CTLG或联合方法的识别率。约20%的患者检测到多个SN。
CTLG与染料引导法联合应用能够在乳腺癌手术前识别SN。与单独使用染料引导法相比，SN识别更容易，且与单独使用任何一种方法相比，识别率均有所提高。该联合方法在肥胖患者中尤其有用。对于有多个SN的患者，联合方法还有助于准确进行SN活检的进一步优势。CTLG在淋巴结阳性患者和淋巴管阻塞患者中可能会产生假阴性结果。
