Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg V S, Shriver C, Feldman S, Kusminsky R, Gadd M, Kuhn J, Harlow S, Beitsch P
Cancer Center, Department of Surgery, University of Vermont, Burlington 05405, USA.
N Engl J Med. 1998 Oct 1;339(14):941-6. doi: 10.1056/NEJM199810013391401.
Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings.
We enrolled 443 patients with breast cancer. The technique involved the injection of 4 ml of technetium-99m sulfur colloid (1 mCi [37 MBq]) into the breast around the tumor or biopsy cavity. "Hot spots" representing underlying sentinel nodes were identified with a gamma probe. Sentinel nodes subjacent to hot spots were removed. All patients underwent a complete axillary lymphadenectomy.
The overall rate of identification of hot spots was 93 percent (in 413 of 443 patients). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The accuracy of the sentinel nodes with respect to the positive or negative status of the axillary nodes was 97 percent (392 of 405); the specificity of the method was 100 percent, the positive predictive value was 100 percent, the negative predictive value was 96 percent (291 of 304), and the sensitivity was 89 percent (101 of 114). The sentinel nodes were outside the axilla in 8 percent of cases and outside of level 1 nodes in 11 percent of cases. Three percent of positive sentinel nodes were in nonaxillary locations.
Biopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient.
初步研究表明，对放射性前哨淋巴结（即最先接收肿瘤引流的淋巴结）进行探针引导下切除，能够识别乳腺癌患者的区域转移情况。为证实这一发现，我们开展了一项多中心研究，观察11位外科医生在不同实际操作环境中使用该方法的情况。
我们纳入了443例乳腺癌患者。该技术是将4毫升99m锝硫胶体（1毫居里[37兆贝可]）注入肿瘤周围或活检腔周围的乳腺组织。用γ探针识别代表潜在前哨淋巴结的“热点”。切除热点下方的前哨淋巴结。所有患者均接受了完整的腋窝淋巴结清扫术。
热点识别总体率为93%（443例患者中的413例）。将前哨淋巴结的病理状态与其余腋窝淋巴结的病理状态进行比较。前哨淋巴结对于腋窝淋巴结阳性或阴性状态的准确率为97%（405例中的392例）；该方法的特异性为100%，阳性预测值为100%，阴性预测值为96%（304例中的291例），敏感性为89%（114例中的101例）。8%的病例中前哨淋巴结位于腋窝外，11%的病例中前哨淋巴结位于Ⅰ级淋巴结外。3%的阳性前哨淋巴结位于非腋窝部位。
前哨淋巴结活检能够预测乳腺癌患者腋窝淋巴结转移的有无。然而，该操作在技术上可能具有挑战性，成功率因外科医生和患者特征而异。
