López-Prior V, Díaz-Expósito R, Casáns Tormo I
Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España.
Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España.
Rev Esp Med Nucl Imagen Mol. 2017 Jul-Aug;36(4):212-218. doi: 10.1016/j.remn.2016.11.004. Epub 2017 Mar 27.
The aim of this study was to review the feasibility of selective sentinel lymph node biopsy in patients with previous surgery for breast cancer, as well as to examine the factors that may interfere with sentinel node detection.
A retrospective review was performed on 91 patients with breast cancer and previous breast surgery, and who underwent sentinel lymph node biopsy. Patients were divided into two groups according to their previous treatment: aesthetic breast surgery in 30 patients (group I) and breast-conserving surgery in 61 (group II). Lymphoscintigraphy was performed after an intra-tumour injection in 21 cases and a peri-areolar injection in 70 cases. An analysis was made of lymphatic drainage patterns and overall sentinel node detection according to clinical, pathological and surgical variables.
The overall detection of the sentinel lymph node in the lymphoscintigraphy was 92.3%, with 7.7% of extra-axillary drainages. The identification rate was similar after aesthetic breast surgery (93.3%) and breast-conserving surgery (91.8%). Sentinel lymph nodes were found in the contralateral axilla in two patients (2.2%), and they were included in the histopathology study. The non-identification rate in the lymphoscintigraphy was 7.7%. There was a significantly higher non-detection rate in the highest histological grade tumours (28.6% grade III, 4.5% grade I and 3.6% grade II).
Sentinel lymph node biopsy in patients with previous breast surgery is feasible and deserves further studies to assess the influence of different aspects in sentinel node detection in this clinical scenario. A high histological grade was significantly associated with a lower detection.
本研究旨在评估对曾接受乳腺癌手术的患者进行选择性前哨淋巴结活检的可行性，并探讨可能影响前哨淋巴结检测的因素。
对91例曾接受乳腺癌手术且随后接受前哨淋巴结活检的患者进行回顾性分析。根据先前治疗情况将患者分为两组：30例行美容性乳房手术的患者为I组，61例行保乳手术的患者为II组。21例患者在肿瘤内注射，70例患者在乳晕周围注射后进行淋巴闪烁显像。根据临床、病理和手术变量对淋巴引流模式和前哨淋巴结总体检测情况进行分析。
淋巴闪烁显像中前哨淋巴结的总体检测率为92.3%，腋窝外引流率为7.7%。美容性乳房手术后（93.3%）和保乳手术后（91.8%）的识别率相似。两名患者（2.2%）在对侧腋窝发现前哨淋巴结，并纳入组织病理学研究。淋巴闪烁显像中的未识别率为7.7%。组织学分级最高的肿瘤未检测率显著更高（III级为28.6%，I级为4.5%，II级为3.6%）。
对曾接受乳房手术的患者进行前哨淋巴结活检是可行的，值得进一步研究以评估在这种临床情况下不同因素对前哨淋巴结检测的影响。组织学分级高与检测率低显著相关。
