Tamayo Carabaño D, Álvarez Pérez R, De Bonilla Damiá Á, Acevedo Bañez I, Pachón Garrudo V M, Jiménez-Hoyuela García J M
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2019 May-Jun;38(3):140-146. doi: 10.1016/j.remn.2018.11.006. Epub 2018 Dec 27.
Sentinel lymph node biopsy (SLNB) usefulness in breast carcinoma N+ converted to N0 after neoadjuvant chemotherapy (NC).
Descriptive study including 16 females with infiltrating carcinoma with lymphatic metastasis confirmed by biopsy, leaving a metallic marker (MM) in pathological lymph nodes (LN). All patients underwent NC reaching a complete radiological response in LN. Lymphoscintigraphy was performed after Tc nanocoloid injection, obtaining planar images and SPECT/CT. Lymphatic drainage and concordance of sentinel node (SN) with MM was analyzed.
SN was visualized in lymphoscintigraphy in 93.7% of cases. The SN coincided with the MM in 12/15 cases on SPECT/CT. The SLNB technique was completed on 14/16 patients, intraoperatively locating the GC in all of them. The SN was negative in 10 cases, 3 cases presented macrometastases and 1 micrometastases. Axillary lymphadenectomy (AL) was performed in a case of macrometastasis with>15,000cp/μARNm CK-19, absence of drainage and in one case that showed no coincidence with the MM due different Berg's level location. These last two cases presented lymph node metastasis. In the other two cases with not coincidence between the SN and the MM, a total of 4 lymph nodes were removed, showing no evidence of metastasis. Patients without AL were followed up for an average of 10 months (range 6-17), with no evidence of lymph node involvement.
SLNB in breast cancer with conversion into N0 after neoadjuvant treatment is a technique with good results and a low false negative rate.
探讨前哨淋巴结活检（SLNB）在新辅助化疗（NC）后乳腺癌N+转化为N0患者中的应用价值。
描述性研究，纳入16例经活检证实有淋巴转移的浸润性癌女性患者，在病理淋巴结（LN）中留置金属标记物（MM）。所有患者均接受NC，LN达到完全放射学缓解。注射锝纳米胶体后行淋巴闪烁显像，获取平面图像和SPECT/CT图像。分析淋巴引流情况以及前哨淋巴结（SN）与MM的一致性。
93.7%的病例在淋巴闪烁显像中可见SN。12/15例在SPECT/CT上SN与MM相符。14/16例患者完成了SLNB技术，术中均成功定位前哨淋巴结。SN阴性10例，3例出现大转移灶，1例出现微转移灶。1例大转移灶（>15,000cp/μARNm CK-19）、无淋巴引流且1例因Berg分级位置不同导致SN与MM不相符的患者行腋窝淋巴结清扫术（AL）。这最后2例出现淋巴结转移。另外2例SN与MM不相符的患者共切除4枚淋巴结，未见转移证据。未行AL的患者平均随访10个月（6 - 17个月），无淋巴结受累证据。
新辅助治疗后转化为N0的乳腺癌患者行SLNB技术效果良好，假阴性率低。
