Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia; The Mater Hospital, North Sydney, Australia; Royal North Shore Hospital, St Leonards, Australia; Sydney Adventist Hospital, Wahroonga, Australia.
Eur J Surg Oncol. 2013 Oct;39(10):1053-60. doi: 10.1016/j.ejso.2013.06.006. Epub 2013 Jul 18.
To test the hypothesis that sub-areolar (SA) lymphoscintigraphy (LSG) identifies the same sentinel node as peri-tumoural (PT) injections.
It is commonly believed that all LSG techniques will identify the same sentinel lymph nodes (SLN) draining the breast. Hybrid imaging technology (SPECT/CT) allows accurate identification of the exact location of SLNs. Using SPECT/CT SA and PT LSG techniques were compared.
In a multi-centre trial 39 patients sequentially underwent LSG (SA followed by PT) separated by 2-7 days. Patients were referred by 4 surgeons to 3 LSG centres, with standardization of isotope (99mTc-antimony sulfide colloid), LSG and SPECT/CT evaluation techniques. LSG were evaluated for SLN concordance and degree of discordance in the axilla and internal mammary nodes (IMN).
39 eligible patients, median age 62 years, were recruited. Successful axillary SLN mapping for SA and PT injection techniques was 87% and 95% respectively. Successful internal mammary SLN mapping occurred with SA and PT LSG in 5% and 36% respectively. Discordance was identified in the IMN (39%) and axilla (21%), with an overall rate of discordance between SA and PT LSG of 56%.
There is a high level of discordance in the localization of SLN by these commonly used LSG injection techniques. This discordance has implications for accuracy of axillary and extra-axillary staging and could impact on patient outcome.
验证亚乳晕（SA）淋巴闪烁显像（LSG）与肿瘤周围（PT）注射识别相同前哨淋巴结的假设。
普遍认为，所有 LSG 技术都会识别出引流乳房的相同前哨淋巴结（SLN）。混合成像技术（SPECT/CT）可准确识别 SLN 的的确切位置。本研究使用 SPECT/CT 比较了 SA 和 PT LSG 技术。
在一项多中心试验中，39 例患者连续接受 LSG（SA 后 PT），间隔 2-7 天。4 名外科医生将 39 例患者转诊至 3 个 LSG 中心，标准化同位素（99mTc-硫代锑胶体）、LSG 和 SPECT/CT 评估技术。对 SLN 一致性和腋窝和内乳节点（IMN）的不匹配程度进行 LSG 评估。
共纳入 39 例符合条件的患者，中位年龄 62 岁。SA 和 PT 注射技术的腋窝 SLN 成功映射率分别为 87%和 95%。SA 和 PT LSG 成功映射内乳 SLN 的发生率分别为 5%和 36%。IMN（39%）和腋窝（21%）出现不匹配，SA 和 PT LSG 之间的总体不匹配率为 56%。
这些常用 LSG 注射技术在 SLN 的定位上存在高度不匹配。这种不匹配对腋窝和额外腋窝分期的准确性有影响，并可能影响患者的预后。
