Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Surg Today. 2009;39(5):374-80. doi: 10.1007/s00595-008-3880-x. Epub 2009 Apr 30.
Lymph node status is a key factor in determining the stage of breast cancer and the most appropriate therapy and for predicting the outcome of patients. Accurate identification of sentinel lymph nodes (SLNs) preoperatively is of clinical importance. Sentinel lymph node biopsy (SLNB) causes less lymph edema of the upper arm than axillary lymph node dissection (ALND) with a high accuracy rate and low false-negative rate (FNR). Neoadjuvant chemotherapy (NAC) can be given not only to patients with locally advanced breast cancer, but also to those with axillary lymph node metastasis and an operable tumor. However, SLNB after NAC results in a lower identification rate and a higher FNR than SLNB before treatment. Recently, a hybrid imaging device has been developed, which consists of single photon emission computed tomography (CT, SPECT) and a low-dose CT installed on the same platform. This imaging system offers an easy and safe method of performing SLNB under local anesthesia. To identify the initial cancer stage in patients who will be treated by systemic therapy before surgery, SLNB should be performed prior to systemic treatments, using a well-developed navigating tool, such as SPECT/CT.
淋巴结状态是确定乳腺癌分期和最适当治疗方法以及预测患者预后的关键因素。术前准确识别前哨淋巴结 (SLN) 具有重要的临床意义。与腋窝淋巴结清扫术 (ALND) 相比，前哨淋巴结活检术 (SLNB) 具有更高的准确性和更低的假阴性率 (FNR)，且引起的上臂淋巴水肿程度较轻。新辅助化疗 (NAC) 不仅可用于局部晚期乳腺癌患者，还可用于腋窝淋巴结转移和可手术肿瘤的患者。然而，与治疗前的 SLNB 相比，NAC 后的 SLNB 具有较低的识别率和更高的 FNR。最近，一种混合成像设备已经开发出来，它由单光子发射计算机断层扫描 (CT、SPECT) 和安装在同一平台上的低剂量 CT 组成。该成像系统提供了一种在局部麻醉下进行 SLNB 的简单、安全的方法。为了在术前通过系统治疗来确定患者的初始癌症分期，应在全身治疗前使用 SPECT/CT 等成熟的导航工具进行 SLNB。
