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乳腺癌是威胁女性生命健康的常见恶性肿瘤之一。早期乳腺癌主要通过淋巴结转移。准确的淋巴结分期对于患者的预后和治疗方案的制定至关重要。前哨淋巴结(sentinel lymph node,SLN)活检作为早期可手术切除的乳腺癌患者腋窝淋巴结转移情况的评价标准,在国内外已达成共识[1]。乳腺癌患者在术前行SPECT/CT SLN显像可以帮助临床医生更准确地确定SLN的位置及数目。99Tcm-利妥昔单抗(99Tcm-Rituximab)作为新型淋巴结显像剂,在早期乳腺癌SLN显像研究中已被证实安全、有效[2-3]。因其具备无第Ⅱ、Ⅲ级淋巴结显影、显像成功率高、假阴性率低等特点,有着较好的应用前景。本研究回顾性分析99Tcm-利妥昔单抗 SPECT/CT在乳腺癌SLN中的诊断效能,旨在更好地指导临床医师术中准确检出SLN。
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22例女性乳腺癌患者,肿瘤长径为0.5~4.7(1.7±1.1) cm,其中cT1期(肿瘤长径≤2 cm)19例,cT2期(2 cm<肿瘤长径≤5 cm)3例。其他临床资料详见表1。
项目 例数(%) 肿瘤位置 左乳 9(41) 右乳 11(50) 双乳 2(9) 分布象限 外上 6(27) 外下 3(14) 内上 7(32) 内下 3(14) 中央 1(5) 内上合并外上 1(5) 外下合并外上 1(5) 病灶特点 单灶 19(86) 多灶 3(14) 病理类型 导管内癌 6(27) 浸润性导管癌 15(68) 浸润性特殊癌 1(5) 病理分期 T分期 Tis期 2(9) T1期 17(77) T2期 3(14) N分期 N0期 17(77) N1期 5(23) 表 1 22例女性乳腺癌患者的临床资料
Table 1. Clinical data of 22 female patients with breast cancer
22例患者中,99Tcm- 利妥昔单抗 SPECT/CT显像检出SLN共67枚,其中,1枚者5例(23%)、2枚者6例(27%)、3枚者4例(18%)、4枚者4例(18%)、5枚者2例(9%)、12枚者1例(5%);SPECT/CT检出SLN数量1~3枚者居多(15例,68%),位于腋窝者有20例(91%),同时位于腋窝及锁骨下者有2例(9%)。术中γ探测器检出SLN共81枚,其中1枚者1例(5%)、2枚者6例(27%)、3枚者5例(23%)、4枚者5例(23%)、5枚者3例(14%)、6枚者1例(5%)、12枚者1例(5%);术中检出SLN数量2~4枚者居多(16例,73%)。以患者为单位,99Tcm- Rituximab显像的灵敏度为100%(22/22)、总符合率为100%(22/22);以淋巴结为单位,灵敏度为83%(67/81)、阳性预测值为100%(67/67)、总符合率为83%(67/81)。
22例患者中,有5例患者组织病理学检查结果发现SLN转移(23%),术中行ALND;17例患者未发现SLN转移(77%),未行ALND,仅行SLN切除活检及全乳房切除术。典型病例见图1。
99Tcm-利妥昔单抗SPECT/CT乳腺癌前哨淋巴结显像的临床评价
Clinical evaluation of 99Tcm-Rituximab SPECT/CT sentinel lymph node imaging in breast cancer
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摘要:
目的 探讨99Tcm-利妥昔单抗(99Tcm- Rituximab)SPECT/CT对乳腺癌前哨淋巴结(SLN)的诊断效能。 方法 回顾性分析2019年7月至2020年7月于海南省肿瘤医院经组织病理学检查证实的22例女性乳腺癌患者的临床资料,患者年龄37~73岁(中位年龄50.5岁)。所有患者术前均行99Tcm-利妥昔单抗SPECT/CT显像,分析图像并统计SLN的数量。显像后1~2 h进行手术,术中采用便携式γ探测器探测SLN,以术中检出的SLN数量为“金标准”,评估99Tcm-利妥昔单抗SPECT/CT的诊断效能。 结果 99Tcm-利妥昔单抗SPECT/CT显像共检出SLN 67枚,以1~3 枚者居多(68%,15/22),术中γ探测器共检出SLN 81枚,以2~4 枚者居多(73%,16/22)。以患者为单位,99Tcm-利妥昔单抗显像的灵敏度为100%(22/22)、总符合率为100%(22/22);以淋巴结为单位,灵敏度为83%(67/81)、阳性预测值为100%(67/67)、总符合率为83%(67/81)。 结论 99Tcm-利妥昔单抗 SPECT/CT对乳腺癌SLN的诊断灵敏度及符合率高,具有较好的临床应用性。 -
关键词:
- 乳腺肿瘤 /
- 前哨淋巴结 /
- 利妥昔单抗 /
- 体层摄影术,发射计算机,单光子 /
- 体层摄影术,X线计算机
Abstract:Objective To explore the diagnostic efficiency of 99Tcm-Rituximab SPECT/CT for sentinel lymph node (SLN) in breast cancer. Methods Clinical data of 22 female patients with breast cancer confirmed by histopathological examination in Hainan Cancer Hospital from July 2019 to July 2020 were retrospectively analyzed. The patients aged between 37 and 73 years (the median age was 50.5 years). They underwent 99Tcm-Rituximab SPECT/CT imaging before surgery. The images were analyzed, and the number of SLN was counted. Operation was performed 1–2 h after the imaging, and a portable γ detector was used to detect SLN during the operation. The diagnostic efficacy of 99Tcm-Rituximab was evaluated using the number of SLN detected during the operation as the "gold standard". Results A total of 67 SLNs were detected by SPECT/CT imaging, most of which were 1–3 (68%, 15/22). A total of 81 SLNs were detected by γ detectors during the operation, and the majority of them were 2–4 (73%, 16/22). The sensitivity of 99Tcm-Rituximab imaging was 100% (22/22) when taking patients as unit, and the total coincidence rate was 100% (22/22). The sensitivity was 83% (67/81), the positive predictive value was 100% (67/67), and the total coincidence rate was 83% (67/81) when taking lymph node as unit. Conclusion 99Tcm-Rituximab SPECT/CT has high sensitivity and coincidence rate in the diagnosis of SLNs in breast cancer, and it has good clinical application. -
表 1 22例女性乳腺癌患者的临床资料
Table 1. Clinical data of 22 female patients with breast cancer
项目 例数(%) 肿瘤位置 左乳 9(41) 右乳 11(50) 双乳 2(9) 分布象限 外上 6(27) 外下 3(14) 内上 7(32) 内下 3(14) 中央 1(5) 内上合并外上 1(5) 外下合并外上 1(5) 病灶特点 单灶 19(86) 多灶 3(14) 病理类型 导管内癌 6(27) 浸润性导管癌 15(68) 浸润性特殊癌 1(5) 病理分期 T分期 Tis期 2(9) T1期 17(77) T2期 3(14) N分期 N0期 17(77) N1期 5(23) -
[1] Yang BL, Ren GS, Song EW, et al. Current status and factors influencing surgical options for breast cancer in China: a nationwide cross-sectional survey of 110 hospitals[J]. Oncologist, 2020, 25(10): e1473−e1480. DOI: 10.1634/theoncologist.2020-0001. [2] 李囡, 林保和, 欧阳涛, 等. 99mTc-美罗华用于原发性乳腺癌前哨淋巴结活检 [J]. 中国医学影像技术, 2009, 25(4): 681−684. DOI: 10.3321/j.issn:1003-3289.2009.04.047.
Li N, Lin BH, Ouyang T, et al. Sentinel lymph node biopsy with a novel sentinel lymphoscintigraphy agent 99mTc-Rituximab for breast cancer[J]. Chin J Med Imaging Technol, 2009, 25(4): 681−684. DOI: 10.3321/j.issn:1003-3289.2009.04.047.[3] Li N, Wang XJ, Lin BH, et al. Clinical evaluation of 99mTc-Rituximab for sentinel lymph node mapping in breast cancer patients[J]. J Nucl Med, 2016, 57(8): 1214−1220. DOI: 10.2967/jnumed.115.160572. [4] Charalampoudis P, Markopoulos C, Kovacs T. Controversies and recommendations regarding sentinel lymph node biopsy in primary breast cancer: a comprehensive review of current data[J]. Eur J Surg Oncol, 2018, 44(1): 5−14. DOI: 10.1016/j.ejso.2017.10.215. [5] Canavese G, Bruzzi P, Catturich A, et al. Sentinel lymph node biopsy versus axillary dissection in node-negative early-stage breast cancer: 15-year follow-up update of a randomized clinical trial[J]. Ann Surg Oncol, 2016, 23(8): 2494−2500. DOI: 10.1245/s10434-016-5177-4. [6] Mansel RE, Fallowfield L, Kissin M, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial[J]. J Natl Cancer Inst, 2006, 98(9): 599−609. DOI: 10.1093/jnci/djj158. [7] 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志, 2019, 29(8): 609−680. DOI: 10.19401/j.cnki.1007-3639.2019.08.009.
China Cancer Association Breast Cancer Specialized Committee. Guidelines and norms for diagnosis and treatment of breast cancer of Chinese Anti-Cancer Association (2019 edition)[J]. China Oncol, 2019, 29(8): 609−680. DOI: 10.19401/j.cnki.1007-3639.2019.08.009.[8] He PS, Li F, Li GH, et al. The combination of blue dye and radioisotope versus radioisotope alone during sentinel lymph node biopsy for breast cancer: a systematic review[J/OL]. BMC Cancer, 2016, 16(1):107[2020-06-03]. https://bmccancer.biomedcentral.com/articles/10.1186/s12885-016-2137-0. DOI: 10.1186/s12885-016-2137-0. [9] 张爱玲, 宾莲洁, 何广宁, 等. 单独或联合使用不同示踪剂在乳腺癌前哨淋巴结活检术中应用的对比研究[J]. 临床和实验医学杂志, 2018, 17(13): 1431−1435. DOI: 10.3969/j.issn.1671-4695.2018.13.027.
Zhang AL, Bin LJ, He GN, et al. A comparative study of single or combined use of different tracers in sentinel lymph node biopsy of breast cancer[J]. J Clin Exp Med, 2018, 17(13): 1431−1435. DOI: 10.3969/j.issn.1671-4695.2018.13.027.[10] 孙嘉忆, 张天一, 郭文斌. 吲哚菁绿联合亚甲蓝在乳腺癌前哨淋巴结活检中的应用价值[J]. 中国医师进修杂志, 2021, 44(3): 254−258. DOI: 10.3760/cma.j.cn115455-20201124-01672.
Sun JY, Zhang TY, Guo WB. The application value of indocyanine green combined with methylene blue in sentinel lymph node biopsy of breast cancer[J]. Chin J Postgrad Med, 2021, 44(3): 254−258. DOI: 10.3760/cma.j.cn115455-20201124-01672.[11] 田少林, 陈波. 亚甲蓝荧光在早期乳腺癌前哨淋巴结定位的临床价值[J]. 临床外科杂志, 2020, 28(11): 1025−1027. DOI: 10.3969/j.issn.1005-6483.2020.11.008.
Tian SL, Chen B. The clinical value of intraoperative methylene blue near-infrared fluorescence imaging and mapping in the sentinel lymph node biopsy of the early stage breast cancer[J]. J Clin Surg, 2020, 28(11): 1025−1027. DOI: 10.3969/j.issn.1005-6483.2020.11.008.[12] 丛斌斌, 孙晓, 宋现让, 等. 新型前哨淋巴结示踪剂的制备及动物实验研究[J]. 中国癌症杂志, 2016, 26(3): 245−250. DOI: 10.3969/j.issn.1007-3969.2016.03.007.
Cong BB, Sun X, Song XR, et al. The preparation and experimental study of a new sentinel lymph node tracer[J]. China Oncol, 2016, 26(3): 245−250. DOI: 10.3969/j.issn.1007-3969.2016.03.007.[13] Tian CL, Sun X, Cong BB, et al. Murine model study of a new receptor-targeted tracer for sentinel lymph node in breast cancer[J]. J Breast Cancer, 2019, 22(2): 274−284. DOI: 10.4048/jbc.2019.22.e28. [14] 袁泉, 王伟. 纳米炭联合亚甲蓝示踪法在乳腺癌前哨淋巴结活检中的应用价值[J]. 中国当代医药, 2021, 28(5): 100−102, 107. DOI: 10.3969/j.issn.1674-4721.2021.05.027.
Yuan Q, Wang W. Application value of nano-carbon combined with methylene blue tracer method in sentinel lymph node biopsy of breast cancer[J]. China Mod Med, 2021, 28(5): 100−102, 107. DOI: 10.3969/j.issn.1674-4721.2021.05.027.[15] 李囡, 林保和, 欧阳涛, 等. 467例乳腺癌患者99Tcm-利妥昔单抗前哨淋巴结显像结果分析[J]. 中华核医学杂志, 2009, 29(1): 3−7. DOI: 10.3760/cma.j.issn.0253-9780.2009.01.002.
Li N, Lin BH, Ouyang T, et al. The results of sentinel lymph node imaging and biopsy with a novel lymphoscintigraphy agent 99Tcm-Rituximab in 467 breast cancer patients[J]. Chin J Nucl Med, 2009, 29(1): 3−7. DOI: 10.3760/cma.j.issn.0253-9780.2009.01.002.[16] Wang JW, Fan T, He YJ, et al. 99mTc-rituximab as a tracer for sentinel lymph node biopsy in breast cancer patients: a single-center analysis[J]. Breast Cancer Res Treat, 2018, 168(2): 365−370. DOI: 10.1007/s10549-017-4591-z. [17] 王雪鹃, 林保和, 杨志, 等. 新型前哨淋巴结显像剂在乳腺癌中的初步应用[J]. 中华肿瘤杂志, 2006, 28(3): 200−203. DOI: 10.3760/j.issn:0253-3766.2006.03.010.
Wang XJ, Lin BH, Yang Z, et al. Preliminary study on a new sentinel lymphoscintigraphy agent 99mTc-Rituximab for breast patient[J]. Chin J Oncol, 2006, 28(3): 200−203. DOI: 10.3760/j.issn:0253-3766.2006.03.010.