核素淋巴显像识别前哨淋巴结在乳腺癌治疗中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌中确定前哨淋巴结(SLN)的应用价值,验证前哨淋巴结活检替代腋窝淋巴结清除术用于乳腺癌治疗的安全性与价值。方法选择1999年6月至2009年11月本院住院的女性乳腺癌患者206例(体检时腋窝均未扪及肿块),应用99Tcm-DX37～74 MBq或99Tcm-SC74 MBq经皮下注射,行核素淋巴显像后,术中注射专利兰1 ml和(或)术中用γ探针定位并行前哨淋巴结活检,与术中冰冻病理检查结果对照。若术中冰冻发现有前哨淋巴结转移,则行腋窝淋巴结清除术,若前哨淋巴结阴性,则不做腋窝淋巴结清除,术后定期随访。结果 206例乳腺癌术中成功活检SLN204例,成功率为99.0%(204/206)。本组有64例仅行SLN切除,术后病理检查证实64例SLN均阴性,故未行腋窝淋巴结清除,其中仅1例于术后1年时出现腋窝淋巴结转移,其余63例患者在随访期间均未发现腋窝淋巴结转移,也未出现同侧上肢水肿、感觉及活动异常;另140例行腋窝淋巴结清除,其中6例经病理证实SLN阳性但腋窝淋巴结为阴性,134例经病理证实SLN阳性35例,阴性99例,腋窝淋巴结阳性37例,阴性97例。核素淋巴显像和γ探针定位法的灵敏度为94.6%(35/37例),准确率为98.5%(138/140),假阴性为5.4%(2/37)。结论核素淋巴显像和γ探针定位应用于乳腺癌是切实可行和可能的,对预测腋窝淋巴结转移有很大的临床实用价值。如技术方法规范,早期乳腺癌前哨淋巴结活检则能取代常规的腋窝淋巴结清除术,乳腺癌手术上肢并发症的发生率可大大降低。

Lymphoscintigraphy to identify sentinel lymph node in the treatment of breast cancer

Objective To assess the value of lymphoscintigraphy and gamma detector porbe in identifying sentinel lymph node in breast cancer, and verify the safety and value of sentinel lymph node biopsy to replace axillary lymph node dissection in breast cancer treatment. Methods Between June 1999 and November 2009, 206 patients with operable invasive breast cancer and clinically proved negative axillary lymph nodes were included in the study. The 99Tcm dextran of 37--74 MBq or/and patent blue dye were injected subdermally around the primary tumor. Lymphoscintigraphy and gamma detector porbe were used to detect the sentinel lymph node （SLN）, and then compared with introperative frozen pathology results. If intraoperative frozen sentinel lymph node metastasis was found, axillary lymph node dissection was performed. If the sentinel lymph node was negative, axillary lymph node dissection was not needed. Patients were followed up regularly after operation. Result SLN was identified in 204 of the 206 breast cancer patients, with the success rate of 99.0%0. In this group 64 cases had SLN resection, and postoperative pathological examination confirmed that their SLN were negative, so they did not have axillary lymph node dissection. Axillary lymph node metastasis occurred in one of the 64 cases one year after operation, and the rest 63 cases were not found with axillary lymph node metastasis or ipsilateral upper extremity edema or abnormal sense during follow-up. The 140 cases had routine axillary lymph node dissection, 6 of them were confirmed pathologically with positive SLN but negative axillary lymph nodes, and in the rest 134 cases, pathologically positive SLN was in 35 patients and negative SLN in 99 cases; and pathologically positive axillary lymph node in 37 cases and negative in 97 cases. The sensitivity and the accuracy of lymphoscintigraphy and gamma detector porhe in identifying SLN and the metastasis of axillary lymph node was 94.6~ （35/37 cases） and 98.50/00 （138/140 cases）, respectively; the false-negative rate was 5.4~ （2/37）. Conclusion Lymphoseintigraphy and the gamma detector probe for detecting SLN is feasible in breast cancer patients and has clinical applicable value in predicting axillary lymph node metastasis. It is a well established technique. Early breast cancer sentinel lymph node biopsy can replace the conventional axillary lymph node dissection, and the incidence of surgical complications in upper limb can be greatly reduced for breast cancer patients.