Shimazu Kenzo, Ito Toshikazu, Uji Kumiko, Miyake Tomohiro, Aono Toyokazu, Motomura Kazuyoshi, Naoi Yasuto, Shimomura Atsushi, Shimoda Masafumi, Kagara Naofumi, Kim Seung Jin, Noguchi Shinzaburo
Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
Department of Surgery, Rinku General Medical Center, Osaka, Japan.
Cancer Med. 2017 Aug;6(8):1915-1922. doi: 10.1002/cam4.1142. Epub 2017 Aug 1.
The aim of this prospective study was to evaluate the feasibility of periareolar injection of the contrast agent Sonazoid (SNZ) followed by ultrasonography (US) for the identification of sentinel lymph node (SLN) in breast cancer patients with clinically negative node. Patients (n = 100) with T1-2N0M0 breast cancer received a periareolar injection of SNZ followed by US to identify contrast-enhanced SLN. Each contrast-enhanced SLN underwent fine needle aspiration cytology (FNAC) followed by SLN biopsy with a conventional method using blue dye and/or radiocolloid (B/R). In almost all cases, contrast-enhanced lymphatic vessels were clearly visualized by US soon after the periareolar injection of SNZ and the SLNs were easily identified with an identification rate of 98% (98/100) for SNZ and 100% (100/100) for B/R. The number of SLNs identified by SNZ (SNZ-SLN) (mean per patient, 1.52) was significantly lower than that identified by B/R (B/R-SLN) (2.19) (P < 0.0001). Twenty-five patients with positive SLNs had at least one positive SNZ-SLN. On a node-by-node basis, sensitivity, specificity, and accuracy of FNAC for SNZ-SLNs (n = 149) were 33.3%, 99.2%, and 85.9%, respectively. Identification of SLN by periareolar injection of SNZ is a technically simple method with an identification rate as high as 98%. SNZ-SLN thus seems to be a good target for FNAC, but sensitivity of FNAC for SNZ-SLNs needs to be improved.
本前瞻性研究的目的是评估乳晕周围注射造影剂声诺维（SNZ）后行超声检查（US），用于识别临床腋窝淋巴结阴性的乳腺癌患者前哨淋巴结（SLN）的可行性。100例T1-2N0M0乳腺癌患者接受乳晕周围注射SNZ后行US检查，以识别造影剂增强的SLN。对每个造影剂增强的SLN进行细针穿刺细胞学检查（FNAC），然后采用使用蓝色染料和/或放射性胶体（B/R）的传统方法进行SLN活检。在几乎所有病例中，乳晕周围注射SNZ后不久，US即可清晰显示造影剂增强的淋巴管，SLN易于识别，SNZ的识别率为98%（98/100），B/R的识别率为100%（100/100）。SNZ识别的SLN数量（SNZ-SLN）（每位患者平均1.52个）显著低于B/R识别的数量（B/R-SLN）（2.19个）（P<0.0001）。25例SLN阳性患者中至少有1个SNZ-SLN阳性。逐节点分析，FNAC对SNZ-SLN（n=149）的敏感性、特异性和准确性分别为33.3%、99.2%和85.9%。乳晕周围注射SNZ识别SLN是一种技术上简单的方法，识别率高达98%。因此，SNZ-SLN似乎是FNAC的良好靶点，但FNAC对SNZ-SLN的敏感性有待提高。
