^99mTc-硫胶体不同注射体积在乳腺癌前哨淋巴结定位中的对比分析  

Comparative analysis of different injection volumes of ^(99m)Tc-sulfur colloid for sentinel lymph node detection in early-stage breast cancer

作　　者：陆晓聆 袁慧瑜[1,2,3,4] 曹天野[1,2,3,4] 李永霞[1,2,3] 马光[1,2,3] 卢麟俊[1,2,3,4] 潘禾戎[1,2,3] 杨忠毅[1,2,3,4] 程竞仪[1,2,3,4] 章英剑[1,2,3,4] LU Xiaoling YUAN Huiyu CAO Tianye LI Yongxia MA Guang LU Linjun PAN Herong YANG Zhongyi CHENG Jingyi ZHANG Yingjian(Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China Center for Biomedical Imaging, Fudan University, Shanghai 200032, China Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai 201315, China Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai 200032, China)

机构地区：[1]复旦大学附属肿瘤医院核医学科,复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学生物医学影像研究中心,上海200032 [3]上海市质子重离子医院核医学科,上海201315 [4]上海分子影像探针工程技术研究中心,上海200032

出　　处：《肿瘤影像学》2017年第3期193-198,共6页Oncoradiology

摘　　要：目的:探讨^(99m)Tc-硫胶体(sulfur colloid,SC)用于早期乳腺癌前哨淋巴结(sentinel lymph node,SLN)活检术的最适注射体积。方法:选择原发性乳腺癌(T_(1~2)N_0M_0)、乳房为中小型-致密型患者150例,按^(99m)Tc-SC注射体积不同分为0.5、1、1.5 mL 3组(每组n=50),术前1 d瘤周深部两点法注射(37 MBq/点),2 h后SPECT显像。比较3组患者腋窝SLN(axillary SLN,ASLN)及内乳SLN(internal mammary SLN,IM-SLN)显像检出率。结果:各组总检出率、ASLN检出率和IM-SLN检出率分别为:96%(48/50)、94%(47/50)、74%(37/50),90%(45/50)、82%(41/50)、68%(34/50),52%(26/50)、32%(16/50)、18%(19/50)。总SLN和ASLN检出率在0.5 mL与1 mL组之间无统计学差异,但0.5 mL与1.5 mL组之间有统计学差异(P=0.001和0.004);IM-SLN检出率在0.5 mL组与其他两组之间有显著性差异(P<0.05)。各组注射疼痛评分分别为3.34±1.02、4.58±1.31和5.06±1.42,疼痛持续时间分别为(3.82±1.64)、(6.00±4.48)和(6.58±4.77)min。0.5 mL组疼痛评分、持续时间显著弱于其他两组(P<0.001)。结论:在中小型-致密型乳房患者中,示踪剂注射体积仅为0.5 mL/点即能获得较好的SLN检出率,且对定位IM-SLN有一定优势;同时小体积注射伴随较少的疼痛感,改善了患者舒适度。Objective： To investigate the optimal injection volume of ^99mTc-sulfur colloid （SC） for sentinel lymph node biopsy in early-stage breast cancer. Methods： A total of 150 early-stage breast cancer patients （T1-2N0M0）（small-medium sized, dense breasts） were enrolled in the study. All patients were given deep injection of 99mTc-SC in two peritumoral points （37 MBq/ point） one day before operation, and assigned to three groups （0.5 mL, 1 mL and 1.5 mL） according to injection volume （n=50 each group）. SPECT was performed 2 h post injection. The detection rates of axillary SLN （ASLN） and internal mammary SLN （IM- SLN） by lymphoscintigraphy in all groups were compared. Results： The overall SLN detection rates were 96% （48/50） in 0.5 mL group, 94% （47/50） in 1 mL group and 74% （37/50） in 1.5 mL group; ASLN detection rates were 90% （45/50）, 82% （41/50） and 68% （34/50）, respectively; IM-SLN detection rates were 52% （26/50）, 32% （16/50） and 18% （9/50）, respectively. There was no significant difference in the overall SLN detection rate and ASLN detection rate between groups 0.5 mL and 1 mL. But there was significant differences between groups 0.5 mL and 1.5 mL （P=0.001 and 0.004）. For IM-SLN detection rate, there were statistical difference between 0.5 mL group and other two groups （P〈0.001）. Injection pain scores were 3.34±1.02, 4.58±1.31, 5.06±1.42, and pain duration were （3.82±1.64）, （6.00±4.48） and （6.58±4.77） min from lower volume group to higher volume group. Group 0.5 mL had lowest injective pain score and shortest pain duration in three groups （P〈0.001）. Conclusion： 0.5 mL/point is the optimal injection volume in small-medium sized dense breasts, with higher SLN detection rate and higher sensitivity in IM-SLN localization. Less injection volume could decrease the pain and improve the comfort degree.

关 键 词：乳腺癌 前哨淋巴结显像 注射体积 疼痛 

分 类 号：R445.5[医药卫生—影像医学与核医学]