De Cicco C, Chinol M, Paganelli G
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
Semin Surg Oncol. 1998 Dec;15(4):268-71. doi: 10.1002/(sici)1098-2388(199812)15:4<268::aid-ssu16>3.0.co;2-i.
Axillary lymph node dissection is an important part of the surgical treatment of breast cancer as a staging procedure. Recent progressive advances in early detection have led to the treatment of small primary carcinomas; thus, a great number of axillary dissections show completely negative lymph nodes. The sentinel node (SN) concept, developed for melanoma patients, seems to be similarly valid in breast cancer and has the potential to change the standard surgical approach in these patients. To verify the accuracy of lymphoscintigraphic method associated with radioguided biopsy of the sentinel node in a large series of patients, we studied 382 patients with operable breast cancer. Lymphoscintigraphy (LS) was performed the day before surgery; three different-sized ranges of 99mTechnetium-labeled colloid particles were injected either by subdermal or peritumoral administration. Planar scans were registered in anterior and oblique projections, and a cutaneous marker was placed over the skin corresponding to the SN as visualized. SNs were localized and removed during surgery, using a gamma-detecting probe (GDP); total axillary dissection was then performed. In 54 patients, blue dye was also administrated in the tumor bed immediately after excision of the primary. LS identified at least one SN in 377 of 382 cases (98.7%). Axillary SN was localized in 371 cases (97.1%). The overall concordance between SN status and other axillary nodes was 96.8% (359 of 371). Localization of the SN was easier when large-size particles of colloidal albumin were injected in a volume of 0.4 ml. GDP successfully localized SN in 54/54 cases (100%), while blue dye identified SN in 37/54 patients (68.5%). In 33 of 37 cases (89%) the dye and LS identified the same node. LS and GDP-guided surgery provide accurate identification and removal of the SN, particularly when large-size radiolabeled colloids are injected in a small volume.
腋窝淋巴结清扫作为一种分期手术，是乳腺癌外科治疗的重要组成部分。早期检测方面的最新进展使得小的原发性癌得以治疗；因此，大量的腋窝清扫显示淋巴结完全阴性。为黑色素瘤患者开发的前哨淋巴结（SN）概念在乳腺癌中似乎同样有效，并且有可能改变这些患者的标准手术方法。为了在大量患者中验证与前哨淋巴结放射性引导活检相关的淋巴闪烁造影方法的准确性，我们研究了382例可手术乳腺癌患者。在手术前一天进行淋巴闪烁造影（LS）；通过皮下或瘤周给药注射三种不同大小范围的99m锝标记的胶体颗粒。在前位和斜位投影下进行平面扫描，并在可视化的对应于前哨淋巴结的皮肤上方放置皮肤标记物。在手术期间使用γ探测探针（GDP）定位并切除前哨淋巴结；然后进行腋窝淋巴结清扫。在54例患者中，在原发性肿瘤切除后立即在肿瘤床中也注射了蓝色染料。LS在382例中的377例（98.7%）中识别出至少一个前哨淋巴结。腋窝前哨淋巴结在371例（97.1%）中被定位。前哨淋巴结状态与其他腋窝淋巴结之间的总体一致性为96.8%（371例中的359例）。当注射0.4 ml体积的大尺寸胶体白蛋白颗粒时，前哨淋巴结的定位更容易。GDP在5 / 54例（100%）中成功定位了前哨淋巴结，而蓝色染料在54例患者中的37例（68.5%）中识别出前哨淋巴结。在37例中的33例（89%）中，染料和LS识别出同一个淋巴结。LS和GDP引导的手术能够准确识别和切除前哨淋巴结，特别是当小体积注射大尺寸放射性标记胶体时。
