Department of Nuclear Medicine, Ege University Hospital, Bornova, 35100 Izmir, Turkey.
Nucl Med Biol. 2010 Oct;37(7):805-10. doi: 10.1016/j.nucmedbio.2010.03.012.
The possible effects of radiocolloid preference on sentinel lymph node biopsy (SLNB) were investigated.
A total of 200 patients with T1-2N0M0 breast cancer were evaluated. The first 100 patients underwent SLNB using (99m)Tc tin colloid (TC) and the next 100 using (99m)Tc nanocolloid (NC). Radiocolloid was injected intradermally at four quadrants of the periareolar region the day before surgery. All patients underwent lymphoscintigraphy 1 h after injection. All nodes having fourfold activity of the background were harvested using gamma probe.
Sentinel lymph node (SLN) identification rate by gamma probe was 98% in each group. The number of SLNs identified by lymphoscintigraphy, gamma probe and pathological evaluation was 1.39 ± 0.7, 1.70 ± 1.0 and 2.23 ± 1.70 in the TC and 2.03 ± 0.94, 2.60 ± 1.36 and 3.05 ± 1.90 in the NC group, respectively (P<.05). Metastatic SLN was found in 24 (24.4%) of 98 patients in the TC group and 41 (41.8%) of 98 patients in the NC group (P=.04). None of the patients showed dispersion to internal mammarian lymph nodes. Lymphatic vessel visualization was observed in eight (8.1%) of 98 TC patients and in 47 (47.9%) of 98 NC patients (P=.000). SLNs were the only metastatic node(s) in 54.1% of TC and 73.1% of NC patients.
The periareolar intradermal injection technique gives a high detection rate in the localization of SLNs independently from the choice of the tracer. Mean SLN numbers and lymphatic vessel visualization frequency were significantly higher using a smaller albumin Tc-99m nanocolloid as compared to a stannous fluoride Tc-99m tin colloid. The results of our study support the idea that the influence of increased number of SLNs on positive SLN frequency is critical.
本研究旨在探讨放射性胶体选择对前哨淋巴结活检（SLNB）的可能影响。
共评估了 200 例 T1-2N0M0 期乳腺癌患者。前 100 例患者采用（99m）Tc 锡胶体（TC）进行 SLNB，后 100 例患者采用（99m）Tc 纳米胶体（NC）。手术前一天，在乳晕周围四个象限皮内注射放射性胶体。所有患者均在注射后 1 小时进行淋巴闪烁显像。使用伽马探针收获所有具有背景四倍活性的淋巴结。
两组患者的伽马探针 SLN 识别率均为 98%。淋巴闪烁显像、伽马探针和病理评估显示，TC 组的 SLN 数量分别为 1.39±0.7、1.70±1.0 和 2.23±1.70，NC 组分别为 2.03±0.94、2.60±1.36 和 3.05±1.90（P<.05）。TC 组中 24 例（24.4%）98 例患者和 NC 组中 41 例（41.8%）98 例患者的 SLN 发生转移（P=.04）。无患者出现内乳淋巴结播散。在 98 例 TC 患者中有 8 例（8.1%）和在 98 例 NC 患者中有 47 例（47.9%）观察到淋巴管可视化（P=.000）。TC 组中有 54.1%的患者和 NC 组中有 73.1%的患者的 SLN 是唯一转移的淋巴结。
无论示踪剂的选择如何，乳晕周围皮内注射技术均可高度定位 SLN。与使用锡酸镧胶体相比，较小的白蛋白 Tc-99m 纳米胶体的平均 SLN 数量和淋巴管可视化频率明显更高。我们的研究结果支持这样一种观点，即 SLN 数量的增加对阳性 SLN 频率的影响至关重要。
