Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Los Angeles Biomedical Research Institute, Torrance, CA, USA.
Ann Surg Oncol. 2018 Oct;25(10):2975-2978. doi: 10.1245/s10434-018-6594-3. Epub 2018 Jun 28.
Sentinel lymph node biopsy (SLNB) historically involves a separate appointment in the Radiology Department to undergo injection of the radiocolloid tracer (RT) the day of, or prior to, surgery, which can lead to disruptions in scheduling. Furthermore, the patient must endure an additional procedure. In a pilot study, intraoperative injection of the RT was previously shown to be equally as effective as preoperative injection. This study evaluates the efficacy of this method in a large cohort and examines factors associated with failure of the RT to reach the axilla.
A retrospective review of patients who underwent SLNB between June 2010 and June 2017 was performed. All patients were injected immediately following intubation with sulfur colloid and blue dye, unless contraindicated. Operative records were reviewed to determine whether sentinel nodes were identified and if gamma counts were detected. Patient and tumor characteristics were examined to identify factors related to failed RT uptake in the axilla.
In 7 years, 453 SLNBs were performed, with sentinel nodes being detected in 447 (98.7%) of these SLNBs. In the six cases where no nodes were detected, all had a prior ipsilateral axillary procedure. Sentinel nodes were undetectable with the gamma probe in 16 (3.5%) cases; a prior axillary procedure was the only statistically significant independent variable associated with this failure.
Intraoperative injection of the RT is highly effective in the detection of sentinel nodes in clinically node-negative breast cancer patients. Eliminating the need for a preoperative injection of RT can avoid scheduling conflicts and decrease patient morbidity.
前哨淋巴结活检 (SLNB) 传统上需要在放射科预约单独的时间，在手术当天或之前注射放射性胶体示踪剂 (RT)，这可能会导致日程安排中断。此外，患者还必须进行额外的程序。在一项试点研究中，先前已经证明术中注射 RT 与术前注射同样有效。本研究在大样本中评估了这种方法的疗效，并研究了与 RT 未能到达腋窝相关的因素。
对 2010 年 6 月至 2017 年 6 月期间接受 SLNB 的患者进行了回顾性研究。所有患者在插管后立即注射硫胶体和蓝染料，除非有禁忌症。检查手术记录以确定是否识别出前哨淋巴结以及是否检测到伽马计数。检查患者和肿瘤特征，以确定与 RT 在腋窝中摄取失败相关的因素。
在 7 年时间里，共进行了 453 例 SLNB，其中 447 例（98.7%）检测到前哨淋巴结。在 6 例未检测到淋巴结的病例中，所有病例均有同侧腋窝手术史。在 16 例（3.5%）病例中，伽马探针无法检测到前哨淋巴结；先前的腋窝手术是与这种失败唯一具有统计学意义的独立变量。
术中注射 RT 对于检测临床淋巴结阴性乳腺癌患者的前哨淋巴结非常有效。消除术前注射 RT 的需要可以避免日程安排冲突并减少患者发病率。
