Barnwell J M, Arredondo M A, Kollmorgen D, Gibbs J F, Lamonica D, Carson W, Zhang P, Winston J, Edge S B
Division of Surgical Oncology, Roswell Park Cancer Institute, State University of New York at Buffalo, 14263, USA.
Ann Surg Oncol. 1998 Mar;5(2):126-30. doi: 10.1007/BF02303845.
Sentinel lymph node biopsy (SNB) in breast cancer may be used in place of axillary lymph node dissection (ALND) if SNB accurately stages the axilla. This study assessed the success and accuracy of axillary SNB with isosulfan blue (ISB) and technetium-99 sulfur colloid (TSC) compared to ALND.
Forty-two women with T1 or T2 breast cancer underwent SNB and ALND. Sixty to 90 minutes before anesthetic induction, a mixture of 3 mL ISB and 1 mCi TSC was injected around the primary cancer or prior biopsy site. Intraoperatively, the SLN was identified using a gamma detector (Neoprobe 1000) or by visualization of the blue-stained lymph node and afferent lymphatics. The SLN was excised separately, and a level I/II ALND was completed. The histologic findings of the axillary contents and SLN were compared.
An axillary SLN was found in 38 of 42 (90%) cases. SLN localization rate and predictive value were the same for women who had and those who had not undergone excisional biopsy before the date of SNB. Fifteen of 42 (36%) patients had lymph node metastases. The SLN was positive in all women with axillary metastases (negative predictive value, 100%).
If confirmed by larger series, a negative SNB may eliminate the need for ALND for select women with breast cancer.
如果前哨淋巴结活检（SNB）能够准确对腋窝进行分期，那么在乳腺癌中它可用于替代腋窝淋巴结清扫术（ALND）。本研究评估了与ALND相比，使用异硫蓝（ISB）和锝-99硫胶体（TSC）进行腋窝SNB的成功率和准确性。
42例T1或T2期乳腺癌患者接受了SNB和ALND。在麻醉诱导前60至90分钟，将3 mL ISB和1 mCi TSC的混合物注射到原发癌或先前活检部位周围。术中，使用γ探测器（Neoprobe 1000）或通过观察蓝色染色的淋巴结及输入淋巴管来识别前哨淋巴结（SLN）。分别切除SLN，并完成I/II级ALND。比较腋窝内容物和SLN的组织学检查结果。
42例患者中有38例（90%）发现了腋窝SLN。在SNB之前接受过切除活检和未接受过切除活检的女性中，SLN定位率和预测价值相同。42例患者中有15例（36%）有淋巴结转移。所有腋窝转移的女性SLN均为阳性（阴性预测值为100%）。
如果经更大规模的系列研究证实，对于部分乳腺癌女性患者，阴性SNB可能无需进行ALND。
