De Cicco C, Cremonesi M, Luini A, Bartolomei M, Grana C, Prisco G, Galimberti V, Calza P, Viale G, Veronesi U, Paganelli G
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
J Nucl Med. 1998 Dec;39(12):2080-4.
Lymphoscintigraphy associated with radioguided biopsy of the sentinel node (SN) is well established in clinical practice for melanoma. In breast cancer, the SN concept is similarly valid, and lymphoscintigraphy is a useful method for localizing the axillary SN. The aim of this study was to optimize the lymphoscintigraphy technique in association with a gamma ray detecting probe (GDP) for identifying and removing the SN in breast cancer patients.
Two-hundred fifty patients with operable breast tumor underwent lymphoscintigraphy before surgery. Three different size ranges of 99mTc-labeled colloid particles (<50, <80 and 200-1000 nm) were used, with either subdermal (above tumor) or peritumoral injection. Early and late scintigraphic images were obtained in anterior and oblique projections, and the skin projection of the detected SN was marked. Sentinel nodes were identified and removed with the aid of the GDP during breast surgery; they were tagged separately. Complete axillary dissection followed. In 40 patients, a blue dye was also administered in addition to subdermal radiolabeled colloid to compare blue dye mapping with lymphoscintigraphy localization.
Lymphoscintigraphy successfully revealed lymphatic drainage in 245 of 250 patients (98%). The axillary SN was identified in 240 patients (96%). SN biopsy correctly predicted axillary node status in 234 of 240 patients (97.5%). Lymphoscintigraphy and GDP detected the SN most easily and consistently when 200-1000 nm colloid was administered subdermally in an injection volume of 0.4 ml. Blue dye mapping was successful in 30 of 40 patients (75%). In 26 of these patients, the dye and lymphoscintigraphy identified the same node; in 4 cases different nodes were identified. None of these four patients had axillary disease.
Lymphoscintigraphy is a simple procedure that is well tolerated by patients. Sentinel node identification is more reliable when large-size radiolabeled colloids are injected in a relatively small injection volume (0.4 ml). Use of a GDP greatly facilitates precise pinpointing and rapid removal of the SN.
在黑色素瘤的临床实践中，淋巴闪烁显像术联合前哨淋巴结（SN）的放射性引导活检已得到充分确立。在乳腺癌中，SN概念同样适用，淋巴闪烁显像术是定位腋窝SN的一种有用方法。本研究的目的是优化与伽马射线探测探头（GDP）相关的淋巴闪烁显像技术，用于识别和切除乳腺癌患者的SN。
250例可手术切除的乳腺肿瘤患者在手术前行淋巴闪烁显像术。使用三种不同大小范围的99mTc标记胶体颗粒（<50、<80和200 - 1000 nm），采用皮下（肿瘤上方）或瘤周注射。在前位和斜位投照下获取早期和晚期闪烁图像，并标记检测到的SN的皮肤投影。在乳腺手术期间借助GDP识别并切除前哨淋巴结；它们被分别标记。随后进行完整的腋窝淋巴结清扫。在40例患者中，除皮下注射放射性标记胶体外还给予了蓝色染料，以比较蓝色染料定位与淋巴闪烁显像术定位。
淋巴闪烁显像术在250例患者中的245例（98%）成功显示了淋巴引流。在240例患者（96%）中识别出腋窝SN。SN活检在240例患者中的234例（97.5%）正确预测了腋窝淋巴结状态。当以0.4 ml的注射量皮下注射200 - 1000 nm胶体时，淋巴闪烁显像术和GDP最容易且一致地检测到SN。蓝色染料定位在40例患者中的30例（75%）成功。在这些患者中的26例，染料和淋巴闪烁显像术识别出同一个淋巴结；在4例中识别出不同的淋巴结。这4例患者均无腋窝疾病。
淋巴闪烁显像术是一种简单的操作，患者耐受性良好。当以相对较小的注射量（0.4 ml）注射大尺寸放射性标记胶体时，前哨淋巴结的识别更可靠。使用GDP极大地便于精确确定和快速切除SN。
