Eser Mehmet, Kement Metin, Kaptanoglu Levent, Gecer Melin, Abamor Evrim, Tutal Firat, Balin Salim, Kurt Necmi, Uzun Huseyin
BMC Surg. 2013 Apr 25;13:13. doi: 10.1186/1471-2482-13-13.
Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session.
Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately.
At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1 ± 1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9 ± 1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection.
The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method.
腋窝淋巴结转移是已知的乳腺癌最重要的预后因素。我们旨在通过在同一患者组的单次手术过程中进行前哨淋巴结活检，研究放射性同位素示踪法对单纯染料法的贡献。
前瞻性纳入2010年2月至2011年10月在我院接受手术、肿块<5 cm且腋窝临床及影像学检查阴性（T1-2 N0）的42例患者。获得石蜡检查结果后，确定所有患者中手术期间无法识别（尽管已染色）但通过γ探测器检测到的淋巴结数量及转移状态、仅染色的淋巴结、仅具有放射性（热）的淋巴结以及既染色又具有放射性（染色-热）的淋巴结。在接受腋窝淋巴结清扫的患者中，分别确定切除的淋巴结总数及其转移状态。
在蓝色染色淋巴结检测阶段，所有患者均至少识别出一个蓝色染色的前哨淋巴结。此阶段切除的前哨淋巴结平均数量为2.1±1.1个。在这41例患者的第二个手术阶段（用γ探测器检查腋窝计数的淋巴结的阶段），至少额外切除了一个热淋巴结，或者因呈蓝色而切除的淋巴结中至少有一个也是热的。除了在染料阶段切除的淋巴结外，从21例患者中切除了34个热淋巴结。总体而言，切除的热淋巴结平均数量为2.9±1.5个。在所有患者中，随后的冰冻切片和组织病理学检查与切除的前哨淋巴结100%一致；首先切除的染色前哨淋巴结不影响进行腋窝清扫的决策。
我们的研究结果表明，仅用染料进行前哨淋巴结活检就足够了，且与联合方法一样有效。
