- 期刊
Radionuclide Sentinel Lymph Node Scan and Biopsy in Breast Cancer: The Experience in a Cancer Center
放射性同位素前哨淋巴結攝影及前哨淋巴結切片於乳癌之應用：一癌症中心醫院之經驗
摘要
背景：腋下淋巴結切除術在過去為常規性之乳癌手術內容，然而往往會造成後遺症，近年來發展的前哨淋巴結切片法，可以避免不必要之腋下淋巴結全切除。本研究之目的是評估早期乳癌病人接受放射性同位素前哨淋巴攝影之偵測率以及前哨淋巴結切片之陰性預測值。 方法：本研究包含49位罹患早期乳癌病人，所有的病人在接受乳癌手術當日或前一日均接受放射性同位素前哨淋巴結攝影檢查。放射性同位素前哨淋巴結攝影使用0.3~1.0毫居之鎝-99m-硫膠體(上標 (99m)Tc-sulfur colloid)注射於腫瘤上方或切片切口周圍之皮下，以加馬攝影機掃描並定位前哨淋巴結，術中輔以加馬偵測探頭進行前哨淋巴結切片，之後再進行腋下淋巴結切除術。所有取出的前哨淋巴結及腋下淋巴結皆以蘇木紫-嗜紅染色進行病理判讀；判讀為陰性之前哨淋巴結再加以細胞角質素(cytokeratin)之免疫組識化學染色排除微小轉移。 結果：所有的前哨淋巴結攝影都成功的偵測到前哨淋巴結，其偵測率為100%。49位病人中，有15位病人被發現有前哨淋巴結的轉移(30.6%)。其他34位病人並無前哨淋巴結的轉移，然而其中一人仍有其他腋下淋巴結轉移，故得到前哨淋巴結切片術之陰性預測值為97.1%。 結論：放射性同位素前哨淋巴結攝影具有極高之偵測率，並能於手術前提供前哨淋巴結的定位。前哨淋巴結切片結果呈現高陰性預測率，可以避免早期乳癌病人接受不必要之腋下淋巴結切除術。
並列摘要
Backgrounds: In the past, axillary lymph node dissection (ALND) was a routine procedure used in the surgery of invasive breast cancer. But procedure related morbidity was not uncommon. Sentinel lymph node (SLN) biopsy is a newly developed method to avoid unnecessary ALND. The purpose of this study was to evaluate the detection rate of radionuclide SLN scan and the negative predictive value of SLN biopsy in early stage breast cancer. Methods: This study included 49 patients of early stage breast cancer. All patients underwent radionuclide SLN scan on the day or the day before surgery. The radionuclide SLN scan was performed with subdermal injection of 0.3.-1.0 mCi of filtered (superscript 99m)Tc-sulfur colloid in the pen-tumor area or area around the scar of excision biopsy. Gamma camera mapping and intraoperative gamma probe were used for SLN biopsy. All SLNs were dissected followed by ALND. All lymph nodes were examined with hematoxylin and eosin (H&E) stain. Immunohistochemistry staining of cytokeratin were done in the SLNs negative on H&E examination to exclude micrometastasis. Results: SLNs were successfully detected by SLN scan in all of patients with detection rate of 100%. Positive SLN metastasis was found in 15 of 49 patients (30.6%), and thirty four patients were negative for SLN metastasis. There was one false negative SLN biopsy and the negative predictive value was 97.1%. Conclusion: Radionuclide SLN scan can provide information about the location and number of SLN(s) before SLN biopsy with high successful rate. The SLN biopsy was predictive for axillary lymph node status and should be used to avoid unnecessary ALND in early stage breast cancer.