Caruso Giuseppe, Cipolla Calogero, Costa Renato, Morabito Alessandra, Latteri Stefania, Fricano Salvatore, Salerno Sergio, Latteri Mario Adelfio
Department of Medical Biotechnologies and Forensic Medicine - Section of Radiological Sciences, AOU Policlinico Paolo Giaccone - University of Palermo, Palermo, Italy.
Acta Radiol. 2014 Feb;55(1):39-44. doi: 10.1177/0284185113493775. Epub 2013 Aug 7.
Preoperative lymphoscintigraphy is without doubt a valid method for the detection of the sentinel lymph node (SLN). There has been considerable debate regarding the optimal site for the introduction of the tracer; various sites include peritumoral (PT), periareolar (PA), subdermal, and intradermal injection.
To evaluate retrospectively the lymphoscintigraphic identification rate of peritumoral (PT) injection versus subdermal periareolar (PA) injection in the detection of SLNs in breast cancer.
Between October 2002 and December 2011, a cohort of 906 consecutive patients with biopsy proven breast cancer underwent 914 SLN biopsy procedures. A total of 339 procedures (Group A) were performed using a PT deep injection of radiotracer while 575 procedures (Group B) adopted a subdermal PA injection of radiotracer towards the upper outer quadrant, regardless of the site of the carcinoma. All the patients underwent synchronous excision of the breast cancer and SLN biopsy.
SLNs were identified in the lymphoscintigram in 308/339 cases (90.85%) of Group A (PT injection) and in 537/575 cases (93.39%) of Group B (PA injection). Furthermore, in 2/339 patients (0.58%) of Group A, internal mammary lymph nodes were found at lymphoscintigraphy, whereas no internal mammary sentinel nodes were found in the Group B patients. The intraoperative identification rate of axillary SLNs was 99.41% (337 of 339) in the Group A patients and 99.65% (573 of 575) in the Group B patients. There was no significant difference in the two groups between the incidence of the number of SLNs detected and the incidence of identification of positive SLNs.
PT versus PA injection of radiotracer showed comparable success rates for axillary SLN identification, and can be considered a rapid and reliable method.
术前淋巴闪烁显像无疑是检测前哨淋巴结（SLN）的有效方法。关于示踪剂注射的最佳部位存在相当多的争论；不同的部位包括肿瘤周围（PT）、乳晕周围（PA）、皮下和皮内注射。
回顾性评估肿瘤周围（PT）注射与乳晕下皮下（PA）注射在乳腺癌前哨淋巴结检测中的淋巴闪烁显像识别率。
2002年10月至2011年12月，906例经活检证实为乳腺癌的连续患者接受了914例前哨淋巴结活检手术。共339例手术（A组）采用肿瘤周围深部注射放射性示踪剂，而575例手术（B组）采用向乳腺外上象限皮下乳晕周围注射放射性示踪剂，无论癌灶部位如何。所有患者均同步进行乳腺癌切除和前哨淋巴结活检。
A组（PT注射）339例中有308例（90.85%）在淋巴闪烁显像中发现前哨淋巴结，B组（PA注射）575例中有537例（93.39%）发现前哨淋巴结。此外，A组2/339例患者（0.58%）在淋巴闪烁显像中发现了内乳淋巴结，而B组患者未发现内乳前哨淋巴结。A组患者腋窝前哨淋巴结的术中识别率为99.41%（339例中的337例），B组患者为99.65%（575例中的573例）。两组在前哨淋巴结检测数量的发生率和阳性前哨淋巴结的识别率方面无显著差异。
放射性示踪剂的PT注射与PA注射在腋窝前哨淋巴结识别方面显示出相当的成功率，可被认为是一种快速可靠的方法。
