乳腺癌前哨淋巴结活检中99mTc-SC显像阴性的意义

目的:分析乳腺癌99mTc-SC前哨淋巴结(SLN)显像阴性的相关影响因素;探讨在乳腺癌SLN活检中,99mTc-SC显像阴性的意义。方法:乳腺癌患者221例,分别采用肿块周围(peritumour,PT)注射法或乳晕周围注射法(periareolar,PA)进行SLN活检,对其中27例显像阴性的患者,分析注射方法、年龄、肿块部位、大小和淋巴结病理组织学情况等与显像阴性的关系。结果:淋巴结肿瘤浸润(P=0·029)、病理BR分级(P=0·032)、孕激素受体(PR)表达(P=0·019)与显像阴性有关。显像阳性与阴性组以及PT与PA组年龄均差异无统计学意义,P值分别为0·214和0·379;但在PT组71~80岁人群以及PA组61~70岁人群,显像阴性率明显增高。结论:PA法较PT法更易于引起显像阴性和假阳性,局部LN肿瘤浸润与肿瘤的恶性程度相关,年龄偏大是引起显像阴性的原因。

Significance in nonvisualization at preoperative 99mTc-SC lymphoscintigraphy

OBJECTIVE:To analyze the significance and relative influence factors of nonvisualized SLNs in patients who had breast cancer undergone preoperative lymphoscintigraphy before SLN biopsy. METHODS:Two hundred and twenty-one patients with breast cancer undrwent with preoperative lymphoscintigraphy before SLN biopsy through either peritumour (PT) or periareolar (PA) injection. Among which 27 patients displayed nonvisualized SLN. Multinomial logistic regression was done between nonvisualization of SLN and injection methods, age, tumour location, size, SLN histologic findings. RESULTS:Nonvisualization of SLN associated with infiltrated SLN (P=0.029),Bloom-Richardson (BR) grade (P=0.037),progestin receptor (PR) expression (P=0.019). There was no difference of age both between PT and PA group, and between visualized and nonvisualized SLN group, P being 0.214 and 0.379 respectively. However, among 71-80yrs in PT group and 61-70yrs group the nonvisualized rate increased significantly. CONCLUSIONS: The higher the BR grade, the easier the nonvisualization of SLN. The dysfunction of radiotracer uptake among tumour infiltrated LNs may account for non-visualization of SLN during SLN scintigraphy. The flab breast tissue in older patients may be another reason for nonvisualization of SLN.