Serrano Vicente J, Infante de la Torre J R, Domínguez Grande M L, García Bernardo L, Durán Barquero C, Rayo Madrid J I, Sánchez Sánchez R, Correa Antúnez M I, Amaya Lozano J L, Conde Martín A F
Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
Rev Esp Med Nucl. 2010 Jan-Feb;29(1):8-11. doi: 10.1016/j.remn.2009.09.003. Epub 2009 Dec 16.
Sentinel node biopsy (SNB) by radioisotopes is a widely accepted and reliable surgical method for staging breast cancer in patients with unknown positive axillary lymph nodes involvement. The main limitation of this method is due to the appearance of false negatives that may be caused by tumor lymph node blockage of the sentinel lymph node and uptake in the neighboring lymph nodes. Infiltered sentinel nodes are generally increased in size and firm. Thus, they can be detected by intraoperative palpation, even when there is no uptake by the radiotracer.
To reduce the false negative rates by applying intraoperative axillary palpation after SNB.
Over a two-year period, we complemented the SNB in 168 patients with careful intraoperative axillary palpation, detecting and removing all the palpable suspicious lymph nodes (SLN) that were analyzed as sentinel nodes
In 32 out of 168 patients, 50 palpable SLN were found. In 3 out of 32 patients, 4 infiltrated SLNs were demonstrated with negative SNB and positive axillary lymphadenectomy. Thus, intraoperative palpation avoided false negative results. In one patient, one palpable SLN with tumor involvement was observed and SNB was also positive. In the remaining 28 patients, the histological analysis of 45 SLN was negative for tumor but SNB was positive in 3 patients.
Intraoperative axillary palpation, once the SNB was done, reduced the false negative rate. Thus, we consider that it should be included as one more part of this procedure.
放射性同位素前哨淋巴结活检（SNB）是一种被广泛接受且可靠的手术方法，用于对腋窝淋巴结转移情况不明的乳腺癌患者进行分期。该方法的主要局限性在于可能出现假阴性结果，这可能是由于前哨淋巴结的肿瘤性淋巴结阻塞以及邻近淋巴结的摄取所致。浸润的前哨淋巴结通常会增大且质地变硬。因此，即使放射性示踪剂未摄取，也可通过术中触诊检测到。
通过在SNB后进行术中腋窝触诊来降低假阴性率。
在两年时间里，我们对168例患者在进行SNB时辅以仔细的术中腋窝触诊，检测并切除所有可触及的可疑淋巴结（SLN），并将其作为前哨淋巴结进行分析。
在168例患者中的32例中，发现了50个可触及的SLN。在32例患者中的3例中，经前哨淋巴结活检为阴性而行腋窝淋巴结清扫术时发现4个浸润性SLN。因此，术中触诊避免了假阴性结果。在1例患者中，观察到1个可触及的SLN有肿瘤累及，前哨淋巴结活检也为阳性。在其余28例患者中，45个SLN的组织学分析未发现肿瘤，但有3例患者的前哨淋巴结活检为阳性。
在完成SNB后进行术中腋窝触诊可降低假阴性率。因此，我们认为应将其纳入该手术的一个环节。
