Department of Plastics-Reconstructive Surgery, Duke University School of Medicine, Durham, NC, USA.
Ann Surg Oncol. 2010 Jan;17(1):220-7. doi: 10.1245/s10434-009-0633-z. Epub 2009 Aug 13.
Controversy exists in the literature regarding the optimal site for lymphatic mapping in breast cancer. This study was designed to characterize lymphatic drainage patterns within the same patient after subareolar (SA) and peritumoral (PT) radiopharmaceutical injections and examine the impact of reader interpretation on reported drainage.
In this prospective trial, 27 women with breast cancer underwent sequential preoperative SA and PT injections of 0.5 to 2.7 mCi of technetium-99 m filtered sulfur colloid 3 days or more apart. Patterns of radiopharmaceutical uptake were reviewed independently by two nuclear medicine physicians. Inter-reader agreement and injection success were assessed in conjunction with observed drainage patterns.
There was near perfect inter-reader agreement observed on identification of axillary LN drainage after PT injection (P = 0.0004) and substantial agreement with SA injection (P = 0.0344). SA injection was more likely to drain to only axillary LNs, whereas PT injection appeared more likely to drain to both axillary and extra-axillary LNs, although no statistically significant differences were found. All patients with extra-axillary drainage after PT injection (n = 6 patients) had only axillary drainage after SA injection. Dual drainage was observed for six patients with PT injection and one patient with SA injection.
Our findings suggest that radiopharmaceutical injected in the SA location has a high propensity to drain to axillary LNs only. After controlling for patient factors and demonstrating inter-reader agreement, the inability to demonstrate statistically significant differences in drainage based on injection site suggests that lymphatic drainage patterns may be a function of patient and tumor-specific features.
在乳腺癌淋巴定位方面，文献中存在争议。本研究旨在描述乳晕下（SA）和肿瘤周围（PT）放射性药物注射后同一患者的淋巴引流模式，并检查读者解读对报告引流的影响。
在这项前瞻性试验中，27 名乳腺癌患者在相隔 3 天或以上的时间内分别进行了 0.5 至 2.7 mCi 的锝-99m 过滤硫胶体 SA 和 PT 注射。两名核医学医师独立审查放射性药物摄取模式。结合观察到的引流模式，评估读者间的一致性和注射成功率。
在识别 PT 注射后腋窝淋巴结（LN）引流方面，读者间几乎达到了完美的一致性（P = 0.0004），与 SA 注射也有很大的一致性（P = 0.0344）。SA 注射更有可能仅引流至腋窝 LN，而 PT 注射似乎更有可能引流至腋窝和腋窝外 LN，尽管没有发现统计学上的显著差异。所有接受 PT 注射后出现腋窝外引流的患者（n = 6 例）在接受 SA 注射后仅出现腋窝引流。PT 注射的 6 例患者和 SA 注射的 1 例患者观察到双重引流。
我们的发现表明，放射性药物注入乳晕下位置时，仅向腋窝淋巴结引流的可能性很大。在控制患者因素并证明读者间一致性后，由于注射部位不能在统计学上显示出引流差异，表明淋巴引流模式可能是患者和肿瘤特异性特征的功能。
