新辅助化疗后乳腺癌患者腋窝前哨淋巴结活检联合碘 125 粒子标记阳性淋巴结的临床研究

Combined procedure of marking axillary positive node with iodine-125 seed and sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy.

机构信息

Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.

出版信息

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2020 Mar-Apr;39(2):75-83. doi: 10.1016/j.remn.2019.09.007. Epub 2019 Nov 20.

DOI:10.1016/j.remn.2019.09.007

Abstract

OBJECTIVE: To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. MATERIAL AND METHODS: Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227±36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients. RESULTS: ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1-3) and AD: 13.5±5.2 (range 7-23). In all cases, histopathological analysis of ML, I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the I radioactive seed was recovered. CONCLUSIONS: Placing of I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy.

摘要

目的：介绍我们在新辅助化疗（NACT）后联合术中检测标记 I 种子（ML）的腋窝阳性淋巴结和前哨淋巴结活检（SLN）的初步经验，用于乳腺癌患者。

材料和方法：前瞻性研究，2017 年 1 月至 2019 年 3 月，16 例 T1-3N1 期乳腺癌患者。TNM 分期：IIA 期：3 例，IIB 期：10 例，IIIA 期：3 例。组织学类型：导管浸润性：14 例。分子亚型：管腔 A：3 例，管腔 B：9 例，HER2：3 例，基底样：1 例。ML 在新辅助化疗前 227±36 天（n=10）或手术前 1-6 天标记，标记物为超声可见性标记、水凝胶（n=3）或三维 3D（n=3）先前确定的淋巴结。10 例患者进行了腋窝淋巴结清扫术。

结果：16 例患者中有 93.7%（15/16）在手术中识别出 ML 和 SLN，在 33.3%（5/15）的病例中，ML 未包含在 SLN 中，只有 1 例患者（1/5）ML 和 SLN 的结果存在差异（大转移灶与阴性 0/2）。SLN 的中位数淋巴结数：2.2±0.9（范围 1-3）和 AD：13.5±5.2（范围 7-23）。在所有病例中，ML、I 种子及其内部的组织病理学分析正确预测了新辅助化疗后的腋窝状态。所有患者均回收了 I 放射性种子。

结论：I 种子的放置是一种可行的技术，用于术中定位新辅助化疗后腋窝阳性淋巴结和 SLN。ML 的组织病理学结果可用于确定新辅助化疗后的腋窝状态。