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目的探讨将示踪剂行乳晕下注射与肿瘤周围注射检测乳腺癌前哨淋巴结(SLN)的可行性及准确性。方法36例临床上腋窝淋巴结阴性的乳腺癌,术前18例患者于乳晕下注射1.0mCi的99mTc硫化胶体,另18例患者于肿瘤周围注射1.0mCi的99mTc硫化胶体,两组术中用手握式同位素探测仪确认有放射活性的SLN,行手术解剖出SLN,所取SLN单独送病检,相应腋窝行淋巴结清扫并常规病检。结果18例乳晕下注射发现SLN者17例,每例SLN平均数目为(1.3±0.7)枚,检出率为94.4%,SLN病检结果预测淋巴结的准确率为94.1%,假阴性1例,假阴性率为5.9%,18例肿瘤周围注射法的患者中发现SLN者16例,每例SLN平均为(2.1±0.9)枚,检出率为88.9%,SLN病检结果预测淋巴结的准确率为87.5%,2例假阴性,假阴性率为12.5%。结论核素法导航定位乳腺癌SLN能准确反映区域淋巴结的转移情况,同时乳晕下注射法比肿瘤周围注射法确定SLN有更高的准确性。
Objective To investigate the feasibility and accuracy of injecting tracer into the areola and injecting the tumor around the sentinel lymph node (SLN) in breast cancer. Methods Thirty-six patients with clinically axillary lymph node-negative breast cancer were enrolled. 18 preoperative patients were injected with 1.0mCi 99mTc colloid under the areola, and the other 18 patients were injected with 1.0mCi 99mTc colloid around the tumor. Isotope detector to confirm the radioactive SLN, surgical dissection of SLN, taken SLN were sent to a separate pathological examination, the corresponding axillary lymph node dissection and routine disease examination. Results 17 cases of SLN were found in 18 cases of SLN. The average number of SLN in each case was (1.3 ± 0.7) pieces, the detection rate was 94.4%. The SLN results showed that the accuracy of lymph node was 94.1%, false negative was 1 case, The false negative rate was 5.9%. Sixteen patients with SLN were found in 18 patients with peritumoral neoplasm. The average SLN of each sample was (2.1 ± 0.9) pieces, the detection rate was 88.9%. The accuracy of SLN in predicting lymph nodes 87.5%, two false negatives and a false negative rate of 12.5%. Conclusion The radionuclide localization of breast SLN can accurately reflect the regional lymph node metastasis, while the injection of the areola pattern is more accurate than the SLN injection of tumor around the injection.