Situ Josephine, Walker Cameron, Jayathungage Don Tharanga D, Suami Hiroo, Chung David K V, Reynolds Hayley M
Department of Engineering Science, The University of Auckland, Auckland, New Zealand.
Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
Breast Cancer Res Treat. 2025 Jan;209(2):283-290. doi: 10.1007/s10549-024-07491-8. Epub 2024 Sep 15.
Sentinel node biopsy (SNB) is a common staging tool for breast cancer. Initially, peritumoral (PT) injections were used, however subareolar (SA) injections were later introduced to simplify the technique. Controversy remains regarding whether PT and SA injections map the same sentinel lymph nodes (SLNs). This study aimed to determine whether the regional location of breast SLNs differs when using PT versus SA injections using a large dataset from a single institution.
A total of 1035 patients who underwent breast SNB (PT injections: n = 858 and SA injections: n = 177) with lymphoscintigraphy and SPECT/CT were included. The identified SLN locations using SA injections were compared with those using PT injections. Differences in drainage proportions and odds ratios (ORs) for each clockface breast region and the whole breast were calculated using a two-proportion z-test and Fisher's Exact Test.
A higher proportion of internal mammary SLNs were identified using PT injections for the whole breast (0.30 versus 0.09) and for all breast regions, with all regions showing statistical significance except the upper outer quadrant. Similarly, ORs showed identification of internal mammary SLNs was significantly higher when using PT injections (4.35, 95% CI 2.53 to 7.95). There were no significant differences in identifying axillary SLNs between injection sites.
This is the largest cohort study to compare the regional location of breast SLNs identified using PT injections versus SA injections. Discordance was shown in the SLNs identified between injection techniques, with PT injections more frequently identifying internal mammary SLNs.
前哨淋巴结活检（SNB）是乳腺癌常用的分期工具。最初使用瘤周（PT）注射，然而后来引入乳晕下（SA）注射以简化技术。关于PT和SA注射是否能标记相同的前哨淋巴结（SLN）仍存在争议。本研究旨在利用来自单一机构的大型数据集，确定使用PT注射与SA注射时乳腺癌SLN的区域位置是否不同。
共纳入1035例行乳腺SNB（PT注射：n = 858；SA注射：n = 177）并接受淋巴闪烁显像和SPECT/CT检查的患者。将使用SA注射确定的SLN位置与使用PT注射确定的位置进行比较。使用双比例z检验和Fisher精确检验计算每个乳房钟面区域和整个乳房的引流比例差异和比值比（OR）。
对于整个乳房（0.30对0.09）以及所有乳房区域，使用PT注射时确定的乳腺内SLN比例更高，除了外上象限外，所有区域均具有统计学意义。同样，OR显示使用PT注射时乳腺内SLN的识别率显著更高（4.35，95%CI 2.53至7.95）。注射部位之间在识别腋窝SLN方面无显著差异。
这是比较使用PT注射与SA注射确定的乳腺癌SLN区域位置的最大队列研究。两种注射技术确定的SLN存在不一致，PT注射更频繁地识别出乳腺内SLN。
