Adamczyk Beata, Dawid Murawa, Karol Połom, Arkadiusz Spychała, Piotr Nowaczyk, Paweł Murawa
Ist Surgical Oncology and General Surgery Department, Wielkopolska Cancer Center, Garbary 15, 61-686 Poznań, Poland.
Ist Surgical Oncology and General Surgery Department, Wielkopolska Cancer Center, Garbary 15, 61-686 Poznań, Poland ; Clinic of Oncology, University of Medical Sciences, Poznań, Poland.
Rep Pract Oncol Radiother. 2011 Oct 15;16(6):221-6. doi: 10.1016/j.rpor.2011.08.004. eCollection 2011.
The aim of this study was to present one center experience in applying the SNOLL technique to patients with suspected occult breast lesions.
In the last years, the widespread use of mammographic screening programs resulted in an increasing number of women with nonpalpable suspicious breast lesions requiring further examination. The new method called sentinel node and occult lesion localization (SNOLL) enables the intraoperative detection of nonpalpable breast tumors and sentinel node biopsy in one surgical procedure.
46 patients with suspected malignant lesions or diagnosed non-palpable breast cancer were subjected to a pre-operative SNOLL procedure. The day before the surgery, they were administered two radiotracers: one to localize the tumor and the other to localize the sentinel node. During the surgery, the breast tumor and the sentinel node, which in most cases had been examined intraoperatively, were detected with a handheld gamma probe and resected under its control.
All 46 (100%) patients had their occult breast lesions resected. Histopathologic examination revealed cancer in 40 patients: in situ in 2 cases, invasive in 38 cases. All these patients had their sentinel nodes examined. In one case only, the sentinel node could not be located with a gamma probe. Intraoperative tests showed the sentinel node to be metastatic in 5 patients, who were then given a simultaneous axillary lymphadenectomy. In addition, the final histopathologic examination revealed metastasis to the sentinel node in one patient, who had to be reoperated.
SNOLL is a modern technique that enables a precise intraoperative localization of non-palpable suspected malignant breast lesions in combination with a sentinel node biopsy. Extended application of intraoperative management leads to significant decrease in the number of reoperations performed in patients with early bread cancer.
本研究的目的是介绍在疑似隐匿性乳腺病变患者中应用前哨淋巴结及隐匿病变定位（SNOLL）技术的单中心经验。
近年来，乳腺钼靶筛查项目的广泛应用导致越来越多触诊不到的可疑乳腺病变女性需要进一步检查。名为前哨淋巴结及隐匿病变定位（SNOLL）的新方法能够在一次外科手术中对触诊不到的乳腺肿瘤进行术中检测并进行前哨淋巴结活检。
46例疑似恶性病变或确诊为触诊不到的乳腺癌患者接受了术前SNOLL程序。手术前一天，给她们注射两种放射性示踪剂：一种用于定位肿瘤，另一种用于定位前哨淋巴结。手术期间，使用手持γ探测器检测乳腺肿瘤和前哨淋巴结（大多数情况下已在术中进行检查），并在其引导下切除。
所有46例（100%）患者的隐匿性乳腺病变均被切除。组织病理学检查显示40例患者患有癌症：2例为原位癌，38例为浸润癌。所有这些患者都对其前哨淋巴结进行了检查。仅在1例中，γ探测器未能找到前哨淋巴结。术中检测显示5例患者的前哨淋巴结有转移，随后对这些患者同时进行了腋窝淋巴结清扫术。此外，最终组织病理学检查显示1例患者的前哨淋巴结有转移，该患者不得不再次手术。
SNOLL是一种现代技术，能够结合前哨淋巴结活检对触诊不到的疑似恶性乳腺病变进行精确的术中定位。术中管理的广泛应用显著减少了早期乳腺癌患者的再次手术次数。
