467例乳腺癌患者^99Tc^m-利妥昔单抗前哨淋巴结显像结果分析

目的探讨应用前哨淋巴结（SLN）显像剂^99Tc^m-利妥昔单克隆抗体（简称利妥昔单抗，美罗华）进行乳腺癌SLN活组织检查（SLNB）的可行性与可靠性，以及不同因素对SLN显像及SLNB的影响。方法467例乳腺癌患者在超声引导下于乳腺肿块周围及肿块表面皮下注射^99Tc^m-利妥昔单抗后行SLN显像。术中凭显像结果行腋窝区SLNB，将切取的SLN行常规HE染色及免疫组织化学检查。结果SLN显像成功率99．14％（463／467），共显示SLN837枚，人均1．79枚（837／467），分布于腋窝区、内乳区、乳腺组织内及锁骨下区。腋窝区SLNB成功率99．57％（465／467），手术共探测到SLN1182枚，人均2．53枚。病理检查发现腋窝SLN有转移者131例，转移SLN194枚。其中1例单纯由免疫组织化学法发现微小转移灶。患者年龄、显像时间、病理类型、临床分期、显像前是否行乳腺肿块手术切取活组织检查对SLN显影率、SLNB成功率及SLN转移率均无影响。不同病理类型及临床分期的患者其SLN转移率的差异有统计学意义（χ^2=14．134，29．184，P均〈0．05）。结论应用^99Tc^m-利妥昔单抗行乳腺癌SLN显像及SLNB成功率较高，具有较好的临床应用前景。

The results of sentinel lymph node imaging and biopsy with a novel lymphoscintigraphy agent 99Tcm-Rituximab in 467 breast cancer patients

Objective The feasibility, reliability and influence factors of sentinel lymph node (SLN) imaging and biopsy with a new imaging agent 99Tcm-Rituximab were investigated in 467 breast cancer patients. Methods The SLN imaging was taken after peritumoral and subdermal injection of 99Tcm-Rituximab guided by ultrasound. Based on the image, the SLN were identified by a gamma probe and removed, the resected SLN were examined pathologically with both HE and immunohistochemical staining. Results The success rate of SLN imaging was 99.14% (463/467). A total 837 SLN (1.79 per case) were visualized, which located in axilla, internal mammary, subraclavicular and breast region. The success rate of SLN biopsy (SLNB) was 99.57% (465/467), a total 1182 SLN (2.53 per case) were identified. Pathological examination showed that there were 131 patients with 194 metastatic axillary SLN; one case of micrometastases was confirmed by immunohistochemical staining, whose result of HE staining was negative. The following factors, such as age, image time, biopsy history, pathologic type and clinical stage, had no effect on the resuits of SLN imaging and SLNB. But the SLN metastasis rates were different in patients with different pathologic type and clinical stage(x2=14.134, 29.184, all P <0.05). Conclusion 99Tcm-Rituximab showed potential in both SLN imaging and identification in breast cancer patients.