Gulec S A, Moffat F L, Carroll R G, Serafini A N, Sfakianakis G N, Allen L, Boggs J, Escobedo D, Pruett C S, Gupta A, Livingstone A S, Krag D N
Division of Nuclear Medicine, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Florida 33136, USA.
J Nucl Med. 1998 Aug;39(8):1388-93.
Thirty-two patients with clinical node-negative breast cancer underwent sentinel node localization study as part of a National Cancer Institute-sponsored multicenter trial. Anatomical and histopathologic characteristics of sentinel lymph node (SLN) and a kinetic analysis of nodal uptake were studied. Patients were injected with 1 mCi/4 ml unfiltered 99mTc-sulfur colloid in four divided doses around the palpable lesion or immediately adjacent to the excision cavity if prior biopsy was performed. SLN biopsy was performed 1.5-6 hr (mean = 3 hr) postinjection. Intraoperative localization was performed using a gamma probe. All patients underwent complete axillary dissection.
SLN was identified in 30 of 32 (94%) patients. There were no false-negative SLN biopsies.
This study supports the clinical validity of SLN biopsy in breast cancer and confirms that, unlike the blue dye technique, the learning curve with unfiltered 99mTc-sulfur colloid and the gamma detection probe is short, and SLN localization is achievable in over 90% of cases by surgeons with modest experience. The use of unfiltered 99mTc-sulfur colloid (larger particle size) with larger injected volume permits effective localization of SLNs.
32例临床腋窝淋巴结阴性的乳腺癌患者接受了前哨淋巴结定位研究，该研究是美国国立癌症研究所资助的多中心试验的一部分。研究了前哨淋巴结（SLN）的解剖学和组织病理学特征以及淋巴结摄取的动力学分析。患者在可触及的病灶周围分4次注射1毫居里/4毫升未过滤的99m锝硫胶体，如果之前已进行活检，则在紧邻切除腔处注射。注射后1.5 - 6小时（平均 = 3小时）进行SLN活检。术中使用γ探测器进行定位。所有患者均接受了完整的腋窝淋巴结清扫术。
32例患者中有30例（94%）成功识别出SLN。未出现假阴性的SLN活检结果。
本研究支持SLN活检在乳腺癌中的临床有效性，并证实，与蓝色染料技术不同，使用未过滤的99m锝硫胶体和γ探测仪的学习曲线较短，经验有限的外科医生在超过90%的病例中能够实现SLN定位。使用未过滤的99m锝硫胶体（较大粒径）和较大的注射体积可有效定位SLN。
