乳腺癌前哨淋巴结显像的临床价值

目的:探讨乳腺癌前哨淋巴结(SLN)显像的临床价值。方法:91例T1-2N0期乳腺肿瘤术前或局部手术后在患者瘤体上方的皮下注射了99mTc-人血清白蛋白(55.5 MBq/0.5ml)或在瘤周乳腺组织注射99mTc-硫胶体(92.5 MBq,/4ml),其中63例进行了乳腺淋巴显像,70例于注射后2-16小时、在腋淋巴清扫术前进行了术中γ探头引导下的乳腺SLN活检。结果:两种示踪剂均能快速显示淋巴结,以0.5h显像结果为准,SLN显像成功率为81％(51/63),13.7％(7/51)的SLN放射性强度低于第二个淋巴结,其中证实85.7％(6/7)存在转移。乳腺内、外侧部肿瘤的内乳SLN出现率为38.5％(5/13)、26.3％(10/38)。SLN活检成功率为95.7％(67/70),SLN数量1.6±1.1只(1-5只)。SLN预测腋窝淋巴结转移的灵敏度、特异性、准确性、PPV和NPV分别为82.75％(24/29)、100％(38/38)、92.53％(62/67)、100％(24/24)和88.37％(38/43)。结论:乳腺前哨淋巴结显像可以了解所显淋巴结的质与量以帮助活检者正确定位SLN,观察乳腺癌淋巴引流个体变异以引导活检部位和制定辅助治疗方案。

The clinical value of mammary sentinel lymphoscintigraphy in breast cancer

Purpose: To evaluate the clinical value of mammary sentinel lymphoscintigraphy in breast cancer. Methods: 91 patients with breast cancer in stage T1-2N0 were injected with 55. 5MBq/0. 5ml 99mTc- human serum albumin on the surface of the lesion subdermally or 92. 5MBq/4ml unfiltered 99mTc-sulfur colloid in four divided doses around the lesion. 63 patients underwent mammary lymphoscintigraphy and sentinel node biopsy using a hand-held r-ray detector probe were performed 2 - 16 hr postinjection in 70 patients during breast surgery . Results: The sentinel lymph node( s) (SLN) could quickly be shown by these two tracers in 81% (51/63) cases . A SLN with low activity could be seen in 13. 7% (7/5.1) cases , in which 85.7%(6/7) were proved to have a metastasis. Lymph drainage to the internal mammary nodes occurred in 38. 5% (5/13) of patients with an inner-lesion and in 26. 3% (10/38) of patients with an outer-lesion . The SLN was successfully identified in 95. 7% (67/70) of the patients and the number of the nodes ranged from 1 -5 with an average 1. 6 per person . The accuracy of the SLN with respect to the positive or negative status of the axillary nodes was 92.53% (62/67) . The sensitivity , specificity, PPV, NPV of the method was 82.75% (24/29), 100% (38/38), 100% (24/24) and 88. 37% (38/43), respectively . Conclusions: Mammary lymphoscintigraphy in breast cancer is helpful for localizing SLN correctly and identifying abnormal lymph drainage.