Title

Value of Nodal Drainage Patterns and Tumor Location from Lymphoscintigraphic Mapping in Detecting Axillary Sentinel Lymph Node Status in Breast Cancer: Experience at Kaohsiung Medical University Hospi

Translated Titles

乳癌淋巴閃爍定位造影中淋巴引流與腫瘤分佈對腋下前哨淋巴狀態之偵測價值-高醫經驗

Authors

陳毓雯(Yu-Wen Chen);賴永昌(Yung-Chang Lai);徐健欽(Chien-Chin Hsu);莊雅雯(Ya-Wen Chuang);侯明鋒(Ming-Feng Hou)

Key Words

前哨淋巴結 ; 淋巴閃爍造影 ; 乳癌 ; sentinel lymph node ; lymphoscintigraphy ; breast cancer

PublicationName

The Kaohsiung Journal of Medical Sciences

Volume or Term/Year and Month of Publication

21卷6期(2005 / 06 / 01)

Page #

251 - 257

Content Language

英文

Chinese Abstract

對乳癌病患的診斷分級與治療而言,前哨淋巴切片是傳統腋下淋巴隨機取樣清除術的替代性方法,本研究中,我們以臺灣病患群為根據,討論在淋巴閃爍造影中,腫瘤分佈與淋巴引流型態,對腋下前哨結狀態之預測。從2001三月至2002十月期間,我們收集88名臨床懷疑或切片診斷乳癌病患,其平均年齡為48±4歲,乳癌臨床分級為T(下標 1-2)N0M(下標 x)。病患接受0.4 to 0.6毫居里鎝99m標誌硫化膠體,腫瘤周邊混合式皮下注射後,前哨淋巴造影(西門子E. CAM)根據本院已建立步驟,於手術十六至十八小時前進行。根據造影結果,定位於病患皮膚上,並於隔日術中以伽瑪偵測筆偵測切片取樣,並送病理診斷。腫瘤分佈如下:外上象限(52.3%)、外下象限(12.5%)、內上象限(17.0%)、內下象限(6.8%)及乳暈周圍(11.4%)。在2小時內前哨淋巴造影中,淋巴引流方向為:單獨腋下方向(76.1%)、單獨內乳方向(1.1%)、同時腋下及內乳方向(11.4%)及不引流(11.4%)。內乳淋巴引流出現與腫瘤位於乳房內側有一定之相關性。其中11.4%病患在2小時內前哨淋巴造影無法偵測者,於隔日術中藉伽瑪偵測筆偵測,可提升至95%前哨淋巴檢測率。術前前哨淋巴定位造影,如同地圖般,在不同腫瘤分佈方位下,提供淋巴引流方向,協助術中前哨淋巴切片取樣有其價值。

English Abstract

Sentinel lymph node (SLN) biopsy is an alternative to axillary node dissection for staging breast cancer treatment. In this article, we investigated nodal drainage patterns and tumor location using lymphoscintigraphy to predict the axillary sentinel lymph node status. We enrolled 88 patients with clinically suspicious or biopsy-proven breast cancer from March 2001 to October 2002. The average age of subjects was 48±4 years and the clinical stage was T(subscript 1-2)N0M(subscript x). Tc-99m sulfur colloid was used in a hybrid combination of subdermal and perilesional injections around the selected corners of the tumor or biopsy site. Sentinel lymphoscintigraphy was performed 16-20 hours before surgery. Sentinel nodes were marked on the skin. An intraoperative gamma probe was used to confirm the sentinel lymph node location before biopsy. Most primary tumors were in the outer upper quadrant (52.3%), followed by the inner upper quadrant (17.0%), outer inferior quadrant (12.5%), central areolar area (11.4%), and inner inferior quadrant (6.8%). The nodal drainage patterns on 2-hour lymphoscintigraphy were as follows: axillary alone (76.1%), internal mammary nodes alone (1.1%), both axillary and internal mammary nodes (11.4%), and no drainage (11.4%). Internal mammary lymphatic drainage is related to tumor location in the inner quadrants of the breast. About 11.4% of all patients had poorly identified SLNs on lymphoscintigraphy within a 2-hour period, but there was improvement in the overall detection rate up to 95% by intraoperative gamma probe the next day. Preoperative lymphoscintigraphic mapping has value in providing individual lymphatic drainage patterns and tumor location that are important in the interpretation of the results of SLN biopsy during surgery.

Topic Category 醫藥衛生 > 醫藥衛生綜合