Pourquier D, Lemanski C, Faurous P, Couty H, Delard R, Rouanet P, Dubois J B
Laboratoire d'anatomie-pathologie, CRLC Val-d'Aurelle, Montpellier.
Bull Cancer. 1998 Aug;85(8):675-84.
Lymphoscintigraphy, after arousing great hope in the past in the field of breast cancer, has now been abandoned. The inability of this examination to predict the metastatic status of the nodes, and progress in therapeutic concepts have led to abandoning this technique. However, certain problems encountered by regional irradiation programmes and the work concerning sentinel node detection may bring this technique back into the spotlight. Lymphoscintigraphy may make it possible to adopt an individual approach, case by case, of the lymphatic drainage basins in breast tumors, thus enabling certain patients to benefit from regional irradiation when it would not have been traditionally recommended for this irradiation. Another aspect concerns the problem of the volumes irradiated. Work carried out with lymphoscintigraphy has enabled internal mammary chain nodes to be precisely located. Theses studies show the necessity of adapting the irradiation field to each individual case, but the clinical impact is limited, in the end, by the low recurrence rate in the internal mammary chain area. However, the new techniques of computer merging of scintigraphic and scanner images could enable the spatial position of the nodes in the upper axillary and supraclavicular regions to be determined. This would have, a priori, much wider clinical impact. Lymphoscintigraphic detection of the sentinel node is another field of major interest, but this technique is in competition with staining techniques. This procedure leads to a large reduction in morbidity of axillary surgery in 70% of patients. The use of techniques for detecting micrometastases in the sentinel node opens prospects in terms of prognosis. The qualities of differents radiotracers and different injection sites possible are also discussed.
淋巴闪烁造影术在过去曾在乳腺癌领域寄予厚望，但如今已被摒弃。该检查无法预测淋巴结的转移状态，以及治疗理念的进步导致了这项技术被弃用。然而，区域照射方案遇到的某些问题以及前哨淋巴结检测方面的工作可能会使这项技术重新受到关注。淋巴闪烁造影术或许能够针对乳腺肿瘤的淋巴引流区域逐例采用个体化方法，从而使某些患者在传统上不建议进行区域照射时也能受益于该照射。另一个方面涉及照射体积的问题。通过淋巴闪烁造影术开展的工作已能够精确确定内乳链淋巴结的位置。这些研究表明有必要根据每个具体病例调整照射野，但最终临床影响因内乳链区域的低复发率而受限。然而，闪烁造影图像与扫描图像的计算机融合新技术能够确定腋窝上部和锁骨上区域淋巴结的空间位置。这在理论上会产生更广泛的临床影响。前哨淋巴结的淋巴闪烁造影检测是另一个备受关注的主要领域，但这项技术与染色技术存在竞争。该方法可使70%的患者腋窝手术的发病率大幅降低。在前哨淋巴结中检测微转移的技术应用为预后带来了前景。文中还讨论了不同放射性示踪剂的特性以及可能的不同注射部位。
