乳腺癌内乳前哨淋巴结活检核素示踪技术优化研究

doi:10.19401/j.cnki.1007-3639.2023.02.006

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (2): 134-141.doi: 10.19401/j.cnki.1007-3639.2023.02.006

乳腺癌内乳前哨淋巴结活检核素示踪技术优化研究

段宝伟¹^,²^,³(), 赵娜⁴, 毕钊¹^,², 邱鹏飞¹^,², 许兴和³, 陈玉光¹^,², 樊庆达¹^,², 王永胜¹^,²()

1.山东第一医科大学（山东省医学科学院）研究生部，山东济南 250118
2.山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心，山东第一医科大学（山东省医学科学院），山东济南 250117
3.泰安市肿瘤防治院乳腺外科，山东泰安 271000
4.泰安市妇幼保健院儿科，山东泰安 271000

收稿日期:2022-11-15 修回日期:2023-02-08 出版日期:2023-02-28 发布日期:2023-03-22
通信作者: 王永胜（ORCID: 0000-0001-6252-684X），博士，主任医师，山东省肿瘤医院乳腺病中心主任。
作者简介:段宝伟（ORCID: 0000-0002-9322-6097），山东第一医科大学硕士研究生。
王永胜，二级教授、博士研究生导师，山东省肿瘤医院乳腺病中心主任。现任中国抗癌协会乳腺癌专业委员会副主任委员，中国抗癌协会国际医疗交流分会副主任委员，中国临床肿瘤学会乳腺癌专家委员会常务委员，中国医师协会肿瘤分会乳腺癌学组副组长，中华医学会肿瘤学分会乳腺癌学组委员，国家卫健委乳腺癌诊疗规范专家组成员，全球乳腺癌大会国际指导专家委员会成员，山东省抗癌协会靶向治疗分会主任委员。于国内率先开展乳腺癌保留乳房手术、前哨淋巴结活检替代腋窝淋巴结清扫术、乳腺病变微创诊断等研究，作为组长单位和首席专家，牵头开展了中国临床早期乳腺癌前哨淋巴结活检替代腋窝清扫术的多中心研究、乳腺癌内乳区前哨淋巴结活检术的多中心前瞻性临床验证研究和新型示踪技术引导乳腺癌内乳前哨淋巴结活检的多中心前瞻性临床研究，研究成果已达到国际领先水平，并参与多项国际和国内乳腺癌Ⅲ期临床研究。以第一作者或通信作者发表论文200余篇，其中在SCI收录期刊上发表论文60余篇，出版专著（译著等）共4部，授权国家发明专利2项，获奖成果共5项，其中国家级1项、部（省）级4项，作为主要负责人承担国家级项目4项、部（省）级项目3项。
基金资助:
国家自然科学基金(81672638);山东省自然科学基金(ZR2021QH002)

Radiotracer technique optimization for breast cancer internal mammary sentinel lymph node biopsy

DUAN Baowei¹^,²^,³(), ZHAO Na⁴, BI Zhao¹^,², QIU Pengfei¹^,², XU Xinghe³, CHEN Yuguang¹^,², FAN Qingda¹^,², WANG Yongsheng¹^,²()

1. Graduate Department of Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250118, Shandong Province, China
2. 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
3. Department of Breast Surgery, Taian Tumor Hospital, Taian 271000, Shandong Province, China
4. Department of Pediatrics, Taian Maternity and Child Health Hospital, Taian 271000, Shandong Province, China

Received:2022-11-15 Revised:2023-02-08 Published:2023-02-28 Online:2023-03-22
Contact: WANG Yongsheng

摘要/Abstract

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。

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

Abstract:

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 by γ probe. 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, respectively, and the intraoperative visualization rate of IMSLN was significantly higher in group B patients aged ≤50 years than in patients aged >50 years (81.58% vs 60.00%, P=0.037). The median in vitro radioactivity count of IMSLN was significantly higher in group A than in group B (160.50 vs 59.00, P=0.005). Conclusion: The optimized radiotracer technique can effectively increase the lymphatic drainage and uptake in the internal mammary region of the radiotracer, which can significantly improve the visualization rate of IM-SLN without affecting the visualization rate of ASLN, and is conducive to the promotion and application of IM-SLNB.

Key words: Breast cancer, Internal mammary sentinel lymph node, Sentinel lymph node biopsy, Modified radiotracer technique

中图分类号:

R737.9

段宝伟, 赵娜, 毕钊, 邱鹏飞, 许兴和, 陈玉光, 樊庆达, 王永胜. 乳腺癌内乳前哨淋巴结活检核素示踪技术优化研究[J]. 中国癌症杂志, 2023, 33(2): 134-141.

DUAN Baowei, ZHAO Na, BI Zhao, QIU Pengfei, XU Xinghe, CHEN Yuguang, FAN Qingda, WANG Yongsheng. Radiotracer technique optimization for breast cancer internal mammary sentinel lymph node biopsy[J]. China Oncology, 2023, 33(2): 134-141.

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参考文献 19

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Characteristic	Group A (n=81)	Group B (n=78)	P value	Characteristic	Group A (n=81)	Group B (n=78)	P value
Median age (range)/year	51 (31-68)	51 (23-69)	0.762	Tumor type			0.491
Age range				HR⁺	55	50
≤50 years	39	38		HER2⁺	17	22
>50 years	42	40		TNBC	9	6
Menopausal status			0.669	Tumor location			0.753
Pre	44	45		UOQ	35	34
Post	37	33		LOQ	13	9
T stage			0.448	UIQ	21	18
T₁	40	43		LIQ	2	4
T₂	39	31		Central	10	13
T₃	2	4		Surgery			0.255
Pathological type			0.979	Mastectomy	69	61
CIS	9	10		Breast preserving surgery	12	17
IDC	66	64		Time intervals between injection and SLNB			0.586
ILC	2	1		≤12 h	37	39
Others	4	3		>12 h	44	39

Characteristic	Group A (n=81)	Group B (n=78)	P value
Location of SLN
Axilla only	36	39
Axilla+IMN	40	37
IMN only	0	0
No location	5	2
Total axilla	76	76	0.443
Total IMN	40	37	0.806

Characteristic	Group A (n=81)	Group B (n=78)	P value
Location of SLN
Axilla only	10	23
Axilla+IMN	69	55
IMN only	2	0
No location	0	0
Total axilla	79	78	0.497
Total IMN	71	55	0.008

乳腺癌内乳前哨淋巴结活检核素示踪技术优化研究

Radiotracer technique optimization for breast cancer internal mammary sentinel lymph node biopsy

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