摘要
背景与目的:山东省肿瘤防治研究院(山东省肿瘤医院)乳腺病中心前期研发新型核素示踪技术,显著提高了内乳前哨淋巴结(internal mammary sentinel lymph node,IMSLN)显像率,但该技术获得的IMSLN显像率相较于腋窝前哨淋巴结(axillary sentinel lymph node,ASLN)仍然存在一定差距。本研究旨在通过优化新型核素示踪技术,进一步提高IMSLN显像率,推动内乳前哨淋巴结活检(internal mammary sentinel lymph node biopsy,IM-SLNB)广泛应用。方法:前瞻性入组159例原发性乳腺癌患者,分为优化核素示踪技术组(n=81,A组)和新型核素示踪技术组(n=78,B组)。A组在超声引导下将99mTc-硫胶体平均注射在腺体最丰富的3个区域腺体实质内(总放射强度1.0~1.3 mCi;0.8~1.0 mL/点)。B组在超声引导下将99mTc-硫胶体平均注射在乳腺6点和12点腺体实质内(总放射强度1.0~1.3 mCi;0.8~1.0 mL/点)。术前进行单光子发射计算机断层扫描(single photon emission computed tomography,SPECT)/计算机体层成像(computed tomography,CT)淋巴显像,术中γ探测仪探测前哨淋巴结。比较两组患者IMSLN及ASLN显像率的差异,同时分析可能影响IMSLN显像率的因素。结果:术前SPECT/CT IMSLN显像率在两组间差异无统计学意义(P=0.806)。术中IMSLN显像率A组显著高于B组(87.65%vs 70.51%,P=0.008)。亚组分析显示,A组年龄≤50岁和>50岁患者术中IMSLN显像率分别为92.31%和83.33%(P=0.315),B组年龄≤50岁患者术中IMSLN显像率显著高于>50岁患者(81.58%vs 60.00%,P=0.037)。A组IMSLN的中位体外放射性计数显著高于B组(160.50 vs 59.00,P=0.005)。结论:优化核素示踪技术能有效地增加核素内乳区淋巴引流及摄取,可在不影响ASLN显像率的同时显著提高IMSLN显像率,有利于IM-SLNB推广应用。
Background and purpose:The modified injection technique developed in Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences has significantly improved the visualization rate of internal mammary sentinel lymph nodes(IMSLN),however there is still a gap between the visualization rate of IMSLN obtained by this technique and that of axillary sentinel lymph nodes(ASLN).The study aimed to further improve the IMSLN visualization rate and promote the widespread use of internal mammary sentinel lymph node biopsy(IM-SLNB)by optimizing the modified injection technique.Methods:A total of 159 patients with primary breast cancer were enrolled in a prospective group and divided into the optimized radiotracer technique group(group A,n=81)and the modified injection technique group(group B,n=78).In group A,99mTc-sulfur colloid was injected averagely into parenchyma in the gland's three most abundant regions under ultrasound guidance(total radioactive intensity 1.0-1.3 mCi;0.8-1.0 mL/point).In group B,99mTc-sulfur colloid was injected averagely into the parenchyma of the breast at 6 and 12 points under ultrasound guidance(total radioactive intensity 1.0-1.3 mCi;0.8-1.0 mL/point).Single photon emission computed tomography(SPECT)/computed tomography(CT)lymphoscintigraphy was performed preoperatively,and the sentinel lymph nodes were detected intraoperatively byγprobe.In this study,we evaluated the differences in IMSLN and ASLN visualization rates between the groups,and also analyzed the factors that may affect the IMSLN visualization rate.Results:There was no statistically significant difference in visualization rate of IM-SLN measured by preoperative SPECT/CT between the two groups(P=0.806).The intraoperative visualization rate of IM-SLN was significantly higher in group A than in group B(87.65%vs 70.51%,P=0.008).Analysis of subgroups showed that the intraoperative visualization rate of IMSLN was 92.31%and 83.33%(P=0.315)in group A patients aged≤50 years and>50 years,respe
作者
段宝伟
赵娜
毕钊
邱鹏飞
许兴和
陈玉光
樊庆达
王永胜
DUAN Baowei;ZHAO Na;BI Zhao;QIU Pengfei;XU Xinghe;CHEN Yuguang;FAN Qingda;WANG Yongsheng(Graduate Department of Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250118,Shandong Province,China;Department of Breast Cancer Center,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,Shandong Province,China;Department of Breast Surgery,Taian Tumor Hospital,Taian 271000,Shandong Province,China;Department of Pediatrics,Taian Maternity and Child Health Hospital,Taian 271000,Shandong Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2023年第2期134-141,共8页
China Oncology
基金
国家自然科学基金(81672638)
山东省自然科学基金(ZR2021QH002)。
关键词
乳腺癌
内乳前哨淋巴结
前哨淋巴结活检
新型核素示踪技术
Breast cancer
Internal mammary sentinel lymph node
Sentinel lymph node biopsy
Modified radiotracer technique
