Department of Surgical Sciences, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden.
Department of Clinical Pathology, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden.
Br J Surg. 2017 Nov;104(12):1675-1685. doi: 10.1002/bjs.10606. Epub 2017 Sep 6.
Sentinel node biopsy (SNB) using superparamagnetic iron oxide (SPIO) nanoparticles is a novel method in breast cancer. Several studies have verified the non-inferiority of SPIO compared with the standard use of radioisotope Tc with or without blue dye. The aim of the MONOS study presented here was to evaluate the use of SPIO as a sole tracer and the efficacy of tracer injection in the preoperative setting.
This prospective cohort study was carried out in two hospitals, one using Tc and the other SPIO. Tc was injected in the morning of the day of surgery or the day before. SPIO was either injected before surgery in the outpatient clinic or 1 h before the operation.
A total of 338 consecutive patients with breast cancer underwent 343 procedures; SPIO nanoparticles were used in 184 procedures and Tc-labelled tracer in 159. Detection rates for SPIO and Tc were 95·6 and 96·9 per cent respectively (P = 0·537). All nodes with SPIO uptake were coloured brown. Fewer nodes were retrieved with SPIO (mean 1·35 versus 1·89), regardless of whether blue dye was used (P < 0·001). Preoperative SPIO injection (58·7 per cent of procedures), a median of 16 (range 2-27) days before the procedure, was associated with a better tracer-specific detection rate (95·3 versus 86 per cent; P = 0·031) and retrieval of more nodes (mean 1·43 versus 1·03; P < 0·001) than perioperative administration. Skin staining was present in 39·9 per cent of patients, and was related to breast-conserving surgery and periareolar injection.
The use of SPIO alone is a safe alternative, with results comparable to those of the standard dual technique using Tc and blue dye. The efficacy of injection in the preoperative setting simplifies logistics and improves performance. Skin staining can be prevented by a deeper peritumoral injection.
使用超顺磁性氧化铁（SPIO）纳米颗粒的前哨淋巴结活检（SNB）是乳腺癌的一种新方法。几项研究已经验证了 SPIO 与放射性同位素 Tc 单独使用或与蓝染料联合使用相比的非劣效性。这里介绍的 MONOS 研究旨在评估 SPIO 作为单一示踪剂的使用以及术前注射示踪剂的效果。
这项前瞻性队列研究在两家医院进行，一家使用 Tc，另一家使用 SPIO。Tc 在手术当天或前一天的早上注射。SPIO 可以在门诊手术前或手术前 1 小时注射。
共有 338 例连续乳腺癌患者进行了 343 次手术；184 次手术使用 SPIO 纳米颗粒，159 次手术使用 Tc 标记示踪剂。SPIO 和 Tc 的检测率分别为 95.6%和 96.9%（P=0.537）。所有摄取 SPIO 的淋巴结均呈棕色。无论是否使用蓝染料，使用 SPIO 检测到的淋巴结数量均较少（平均 1.35 个比 1.89 个，P<0.001）。术前注射 SPIO（58.7%的手术），中位数为术前 16 天（范围 2-27 天），与更好的示踪剂特异性检测率（95.3%比 86%，P=0.031）和更多淋巴结的检出（平均 1.43 个比 1.03 个，P<0.001）相关。39.9%的患者出现皮肤染色，与保乳手术和乳晕周围注射有关。
单独使用 SPIO 是一种安全的替代方法，结果与使用 Tc 和蓝染料的标准双技术相当。术前注射的效果简化了物流流程并提高了效果。通过更深的肿瘤周围注射可以预防皮肤染色。
