MR间质淋巴造影在VX2兔乳腺癌内乳前哨淋巴结显像中的初步研究  

Preliminary study on the mapping of internal mammary sentinel lymph node of VX2 rabbit breast cancer using magnetic resonance lymphography

作　　者：谭红娜[1] 王攀鸽 刘洋[2] 夏燕娜 王博[1] 肖慧娟[1] 高剑波[1] 

机构地区：[1]郑州大学第一附属医院放射科,河南郑州450052 [2]郑州大学第五附属医院放射科,河南郑州450052

出　　处：《中国癌症杂志》2017年第12期928-934,共7页China Oncology

基　　金：国家青年自然基金项目(81401378)

摘　　要：背景与目的:内乳淋巴结(internal mammary lymph node,IMLN)对乳腺癌远处转移及远期复发的预测价值与腋窝淋巴结的价值相当。IMLN在改良根治术下不能被清除,目前临床上只能对内乳区可能存在转移的患者盲目追加放疗;如何选取适合IMLN活检或切除手术的乳腺癌患者,则是目前临床急需解决的问题。该研究初步探讨MR间质淋巴造影(MR lymphography,MR-LG)检查在显示VX2兔乳腺癌内乳前哨淋巴结(sentinel lymph node,SLN)的可行性。方法:选取纯种雌性新西兰大白兔55只建立VX2兔乳腺癌动物模型,并行MR-LG检查。图像传至ISP(Philips Intellispace Portal)工作站进行后处理,自注射部位至内乳或腋窝方向的引流淋巴管上最先显像的1个或数个淋巴结定义为SLN,记录SLN及引流淋巴管显示情况,并与前哨淋巴结活检(sentinel lymph node biopsy,SLNB)结果对照。结果:55只实验兔建模成功率为98.2%(54/55),最终51只荷瘤兔成功入组。在MR-LG图像上,对比剂注射后5 min扫描较注射后即刻扫描可显示更多的内乳区淋巴管(36 vs 25),且同时显示腋窝SLN及引流淋巴管效果进一步提高(45 vs 37),两者差异均有统计学意义(P=0.021和P=0.040)。在内乳区MR-LG图像上,显像SLN长径为(2.64±0.59)mm,短径为(2.24±0.54)mm,引流淋巴管直径平均值为2.18 mm;肿瘤大小及腋淋巴结数目对内乳淋巴管的显示差异均有统计学意义(P=0.032和P=0.040)。11只荷瘤兔内乳区SLNB共检出内乳区SLN 15枚,位于第2~3肋间者6枚,1~2肋间者5枚,3~4肋间者2枚,而位于第10肋间和剑突旁者各1枚;对照MR-LG,共9只荷瘤兔共显示11枚内乳区SLN,其中7只(77.8%,7/9)与SLNB显示结果一致;SLNB检出的SLN长短径均大于MR-LG图像上显示的SLN,差异均有统计学意义(P<0.05)。结论:MR-LG可显像VX2兔乳腺癌内乳区SLN,但显像率的提高有待进一步研究。Background and purpose： Internal mammary lymph node （IMLN） has a similar predictive value of distant metastasis and long-term recurrence as that of axillary lymph node. IMLN can not be removed under modified radical mastectomy, so the blind radiotherapy can sometimes be applied to the patients with suspected metastasis in the internal mammary region clinically. How to select the breast cancer patients who are suitable for IMLN biopsy or resection is an urgent clinical problem. This study aimed to investigate the feasibility of internal mammary sentinel lymph node （SLN） mapping using magnetic resonance lymphography （MR-LG） in VX2 rabbit breast cancer model. Methods： Fifty-five purebred female New Zealand white rabbits were used to establish the model of VX2 rabbit breast cancer, then MR-LG examinations were performed. The raw images were transferred to Philips IntelliSpace Portal （ISP） workstation for post-processing. The first one or several lymph nodes along the lymph duct draining from the injection sites to axilla or internal mammary were defined as SLN. The SLN and draining lymphatic vessels were recorded, then compared with the results of SLN biopsy （SLNB）. Results： The success rate of model establishment was 98.2% （54/55）, and 51 rabbits were enrolled in this study finally. On MR-LG, compared with the mapping of SLN and lymph ducts immediately after administration of the contrast agent, more internal mammary lymph ducts （36 vs 25,P=-0.021） were shown, and more rabbits with both axillary SLN and lymph ducts mapping were detected （45 vs 37, P=- 0.040） 5 minutes after administration of the contrast agent. On the internal mammary MR-LG, the long diameter, the short diameter of SLN and the diameter of mapping lymph ducts were （2.64±0.59） turn, （2.24±0.54） mm and 2.18 mm, respectively. The size of tumor and the number of axillary lymph nodes had significantly different effects on the mapping of internal mammary lymph ducts （P=0.032 and 0.040, respectively）. Amon

关 键 词：VX2兔乳腺癌 内乳淋巴结 前哨淋巴结 MR间质淋巴造影 

分 类 号：R730.42[医药卫生—肿瘤]