Mathey Marie Pierre, Simonson Colin, Huber Daniela
Department of Gynecology and Obstetrics Valais Hospital, Sion, Switzerland.
The Geneva University Hospitals Geneva, Switzerland.
Eur J Breast Health. 2024 Jul 1;20(3):223-227. doi: 10.4274/ejbh.galenos.2024.2024-3-10.
Sentinel lymph node (SLN) dissection is a highly accurate surgical procedure allowing detection of lymph node invasion in patients with clinically negative axilla in early breast cancer. Superparamagnetic iron oxide (SPIO) is a marker used during SLN procedure, allowing the same detection rate as isotopes (Tc-99). A drawback of SPIO is skin staining that can occur around the injection site. The goal of this retrospective study was to assess the frequency of skin staining after oncological breast surgery with SPIO, and the impact of two different injection protocols on the rate of skin staining.
Data from breast cancer patients undergoing magnetic tracer SLN detection (SLND) procedure in a single department between 2020 and 2022 was reviewed. Injection protocol P1 consisted of retro-areolar injection of Magtrace 0.8 mL. Injection protocol P2, consisted of retro-tumoral injection with 1 mL. Presence of skin staining was assessed at day 10 after surgery. The evolution and satisfaction of the patients was assessed at six and 12 months.
In total 175 sentinel lymph node biopsy procedures were performed (P1: 141/P2: 34), consisting of breast conservative surgery (BCS) (P1: 70%/P2: 53%) or mastectomy (P1: 30%/P2: 47%) with SLN. SLN detection rate was 97.7%. Skin staining was reported in 23% and occurred more often after BCS (31.6%) compared to mastectomy (6.8%). When BCS was performed, peritumoral injection was associated with a decreased risk of skin staining compared with retro-areolar injection (22.2% vs. 33.3%, respectively). When present skin staining persisted for 12 months, but most of the patients described only a slight discomfort. The low rate of discoloration after mastectomy, as previously reported, can be explained by the removal of skin and glandular tissue in which the tracer accumulates. Less skin staining in P2 may be because of a shorter interval between injection and surgery and the removal of the excess of SPIO during the lumpectomy.
SPIO injection is a safe surgical technique. After mastectomy, the rate of discoloration was low. Despite the persistent skin discoloration in 58.6% in our study, patient satisfaction was high. Deeper injection, reduced doses, massage of the injection site and peritumoral injection may reduce skin staining.
前哨淋巴结（SLN）清扫术是一种高度精确的外科手术，可用于检测早期乳腺癌患者临床腋窝阴性时的淋巴结转移情况。超顺磁性氧化铁（SPIO）是在SLN手术中使用的一种标记物，其检测率与同位素（Tc-99）相同。SPIO的一个缺点是注射部位周围可能会出现皮肤染色。这项回顾性研究的目的是评估乳腺癌手术中使用SPIO后皮肤染色的发生率，以及两种不同注射方案对皮肤染色发生率的影响。
回顾了2020年至2022年期间在单一科室接受磁性示踪剂SLN检测（SLND）手术的乳腺癌患者的数据。注射方案P1为乳晕后注射0.8 mL Magtrace。注射方案P2为瘤周注射1 mL。术后第10天评估皮肤染色情况。在术后6个月和12个月评估患者的恢复情况和满意度。
共进行了175例前哨淋巴结活检手术（P1：141例/P2：34例），包括保乳手术（BCS）（P1：70%/P2：53%）或乳房切除术（P1：30%/P2：47%）并清扫SLN。SLN检测率为97.7%。报告有皮肤染色的患者占23%，BCS后发生皮肤染色的情况（31.6%）比乳房切除术后（6.8%）更常见。进行BCS时，瘤周注射与乳晕后注射相比，皮肤染色风险降低（分别为22.2%和33.3%）。出现皮肤染色后可持续12个月，但大多数患者仅表示有轻微不适。如先前报道，乳房切除术后皮肤变色率较低，这可能是由于去除了示踪剂积聚的皮肤和腺体组织。P2组皮肤染色较少可能是因为注射与手术之间的间隔较短，以及在肿块切除术中去除了多余的SPIO。
SPIO注射是一种安全的手术技术。乳房切除术后，变色率较低。尽管在我们的研究中有58.6%的患者皮肤变色持续存在，但患者满意度较高。更深层注射、减少剂量、按摩注射部位和瘤周注射可能会减少皮肤染色。
