乳腺癌前哨淋巴结活检术前腋窝超声引导钢丝定位及淋巴显像

Fezzeh Elyasinia, Homa Hemmasi, K. Toolabi, A. Alikhassi, Mehran Sohrabi Maralani, E. Sadeghian
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引用次数: 0

摘要

背景:乳腺癌是女性恶性肿瘤中发病率和死亡率最高的肿瘤。腋窝淋巴结阴性的乳腺癌主要在早期诊断。前哨淋巴结活检(SLNB)是早期乳腺癌和临床阴性淋巴结患者的标准筛查技术。淋巴显像(前哨淋巴结作图)已被经常用作SLNB的标准方法。目前,超声引导钢丝定位(USGWL)是一种成熟的技术,具有良好的效果。因此,我们试图确定术前UGWL和淋巴显像(蓝色染料和同位素注射)是否能提高乳腺癌SLNB患者SLN的检出率和假阴性率,并确定可能影响腋下超声(AUS)诊断准确性的临床因素。方法:2018年12月至2019年6月,在德黑兰伊玛目霍梅尼医院(Imam Khomeini Hospital)接受SLNB治疗的55例临床T1- 3N0乳腺癌患者纳入我们的研究。肿瘤特征和人口统计数据是通过回顾病历和外科小组准备的问卷收集的。在SLNB的前一天,所有患者都接受了超声引导下的SLN定位。淋巴显像采用未经过滤的99mtc标记的硫胶体瘤周注射,然后注射亚甲基蓝染料。根据永久性病理报告对结果进行分析。结果:55例患者中,钢丝定位检出率为71.8%,亚甲蓝定位检出率为57.8%,伽玛探针检测检出率为59.6%。与线定位和同位素注入技术相比,亚甲基蓝染料技术的灵敏度较低(72.2%),而线定位和同位素注入技术的灵敏度均为77.8%。UGWL的敏感性为77.8%,特异性为42.1%,准确性为65.4%。亚甲基蓝染料和同位素注射精度分别为47.3%和50.1%。此外,BMI、肿瘤大小、侧边性、反应性ALN与术前AUS的准确性之间存在显著关系。但年龄、体重、身高、肿瘤活检、肿瘤位置、亚甲蓝染色与同位素注射时间间隔、手术类型与术前AUS准确性无显著相关性。结论:与lym-光照术(蓝色染料和同位素注射)相比,术前UGWL能有效识别早期乳腺癌SLNB患者的sln。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preoperative Axillary Ultrasound-guided Wire Localization and Lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer Patients
Background: Breast cancer has the highest incidence and mortality among female malignant tumors. Breast cancer with negative axillary lymph nodes has been diag- nosed mainly at an early stage. Sentinel lymph node biopsy (SLNB) is a standard screening technique for patients with early-stage breast cancer and clinically nega- tive lymph nodes. Lymphoscintigraphy (sentinel lymph node mapping) has been reg- ularly used as the standard method for SLNB. Today, ultrasound-guided wire locali- zation (USGWL) is a well-established technique with superior outcomes. Therefore, we attempted to determine whether preoperative UGWL and lymphoscintigraphy (blue dye and isotope injection) improve SLN detection and false-negative rate in breast cancer patients undergoing SLNB and identify clinical factors that may affect the diagnostic accuracy of axillary ultrasound (AUS). Methods: Between December 2018 and June 2019, 55 patients with clinical T1- 3N0 breast cancer eligible for an SLNB at Imam Khomeini Hospital in Tehran were included in our study. Tumor characteristics and demographic data were collect- ed by reviewing medical records and questionnaires prepared by our surgical team. The day before SLNB, all patients underwent ultrasound-guided wire localization of SLN. Lymphoscintigraphy was performed with an unfiltered 99mTc-labelled sulfur colloid peritumoral injection followed by methylene blue dye injection. The results were analyzed based on the permanent pathology report. Results: Among the 55 patients, 71.8% of SLNs were detected by wire localization, while 57.8% were found by methylene blue mapping and 59.6% by gamma probe detection. Compared with wire localization and isotope injection, the methylene blue dye technique had a low sensitivity (72.2%), while both wire localization and isotope injection reached 77.8%. The sensitivity, specificity, and accuracy of UGWL were 77.8%, 42.1%, and 65.4%, respectively. Otherwise, methylene blue dye and isotope injection accuracy was 47.3% and 50.1%, respectively. Furthermore, there was a significant relationship between BMI, tumor size, laterality, reactive ALN, and the accuracy of preoperative AUS. But there was no significant correlation between age, weight, height, tumor biopsy, tumor location, the time interval between methylene blue dye and isotope injection to surgery, and also the type of surgery to the accuracy of preoperative AUS. Conclusion: Preoperative UGWL can effectively identify SLNs compared to lym- phoscintigraphy (blue dye and isotope injection) in early breast cancer patients un- dergoing SLNB.
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