Bernardi Sergio, Bertozzi Serena, Londero Ambrogio P, Angione Vito, Petri Roberto, Giacomuzzi Francesco
Department of Surgery, Ospedale Civile, AOU 'Santa Maria della Misericordia' eClinic of Obstetrics and Gynecology, University of Udine, Udine, Italy.
Nucl Med Commun. 2013 Jul;34(7):664-73. doi: 10.1097/MNM.0b013e328361cd84.
Sentinel lymph node biopsy (SLNB) has progressively replaced complete axillary lymph node dissection in the evaluation of breast cancer patients with clinically node-negative disease. Our study investigates the rate of and risk factors involved in sentinel node identification failure.
We collected data on SLNBs performed during 2002-2010, focusing on tumor, patient, and breast characteristics, radioactivity parameters, and operators' experience. Data were analyzed by R (v2.14.2), considering significance at P values lower than 0.05.
Among 1050 women who underwent an SLNB, the rate of identification failure was 2% (23/1050), which, on bivariate analysis, was seen to be significantly influenced (P<0.05) by the preoperative and intraoperative low radiotracer uptake (axilla/lesion radiotracer uptake ratio<1%), low level of experience of the specialist in nuclear medicine, luminal A subtype, and radiotracer uptake localization in internal mammary lymph nodes. On multivariate analysis, significant risk factors for sentinel node identification failure were found to be: axilla/lesion radiotracer uptake ratio less than 1%, radiotracer uptake localization in internal mammary lymph nodes, and luminal A subtype. Considering only the preoperative variables in our multivariate analysis, axilla/lesion radiotracer uptake ratio less than 1%, negative lymph node scintiscan, and radiotracer uptake localization in internal mammary lymph nodes had an area under the curve (receiver operating characteristic curve) of 96% (95% confidence interval 92-100%). Further, we built a nomogram based on these simple parameters for counseling the patient about the probability of not finding the sentinel lymph node during the surgical procedure.
The relatively low prevalence of SLNB failure (2%) is indicative of the accuracy of the procedure when performed by experienced surgeons. The sentinel node identification failure in our population seemed to be related to biological tumor factors (luminal A subtype) and probably to physiological or pathological variations in the lymphatic drainage (axilla/lesion radiotracer uptake ratio<1% and radiotracer uptake localization in internal mammary lymph nodes).
前哨淋巴结活检（SLNB）已逐渐取代完全腋窝淋巴结清扫术，用于评估临床腋窝淋巴结阴性的乳腺癌患者。我们的研究调查了前哨淋巴结识别失败的发生率及相关危险因素。
我们收集了2002年至2010年期间进行的前哨淋巴结活检的数据，重点关注肿瘤、患者及乳房特征、放射性参数和操作者经验。数据采用R（v2.14.2）进行分析，P值低于0.05时具有统计学意义。
在1050例行前哨淋巴结活检的女性中，识别失败率为2%（23/1050）。在双变量分析中，术前和术中放射性示踪剂摄取低（腋窝/病变放射性示踪剂摄取率<1%）、核医学专家经验不足、管腔A型亚型以及放射性示踪剂在内乳淋巴结中的摄取定位，均对识别失败率有显著影响（P<0.05）。多变量分析显示，前哨淋巴结识别失败的显著危险因素为：腋窝/病变放射性示踪剂摄取率低于1%、放射性示踪剂在内乳淋巴结中的摄取定位以及管腔A型亚型。仅考虑多变量分析中的术前变量时，腋窝/病变放射性示踪剂摄取率低于1%、淋巴结闪烁扫描阴性以及放射性示踪剂在内乳淋巴结中的摄取定位，其曲线下面积（受试者操作特征曲线）为96%（95%置信区间92 - 100%）。此外，我们基于这些简单参数构建了一个列线图，用于向患者咨询手术过程中找不到前哨淋巴结的概率。
前哨淋巴结活检失败的发生率相对较低（2%），表明经验丰富的外科医生进行该手术时具有较高的准确性。我们研究人群中的前哨淋巴结识别失败似乎与肿瘤生物学因素（管腔A型亚型）有关，也可能与淋巴引流的生理或病理变化（腋窝/病变放射性示踪剂摄取率<1%以及放射性示踪剂在内乳淋巴结中的摄取定位）有关。
