PURPOSE:The subareolar and periareolar injection techniques result in higher detection rates and do not require tumor localization in impalpable lesions when compared with the peritumoral technique. One of the main criticisms, however, is the widely reported inability to detect internal mammary nodes. This contrasts with our clinical experience using Tc-99m antimony sulfur colloid, in which internal mammary nodes are commonly seen. METHODS:A retrospective analysis of 241 patients over 38 months was performed to investigate the ability of our periareolar injection technique to detect internal mammary lymph node drainage in breast cancer sentinel node lymphoscintigraphy. Four injections of 5 to 10 MBq (0.14-0.27 mCi) Tc-99m antimony sulfur colloid were administered on the day of surgery followed by massage and imaging. The radioisotope was suspended in 0.1 mL with a 0.5-mL air lock. Each injection was performed over 2 seconds with a 25-gauge needle at a depth of 1.1 to 1.3 cm. Patients whose records could not be retrieved or who underwent an injection technique apart from periareolar or peritumoral were removed from the analysis. RESULTS:One hundred thirty-three patients underwent the periareolar technique, 72 patients underwent the peritumoral technique, and 36 patients were excluded from the analysis. Internal mammary drainage was seen in 24 of 133 (18.0%) patients, of which 12 (9%) were seen only in the internal mammary chain. This is much higher than previous studies quoting 0.0% to 4.3% and is similar to previously reported rates using the peritumoral technique. CONCLUSIONS:Our periareolar injection technique using Tc-99m antimony sulfur colloid is able to detect internal mammary lymph nodes in at least 18.0% of patients.

译文

目的:乳晕下和乳晕周围注射技术与肿瘤周围技术相比,具有更高的检出率,并且不需要将肿瘤定位在无法触及的病变中。然而,主要的批评之一是被广泛报道的无法检测内部乳腺淋巴结。这与我们使用Tc-99m锑硫胶体的临床经验形成对比,在该实验中,通常会看到内部乳腺淋巴结。
方法:回顾性分析了241例患者,历时38个月,以探讨我们乳晕周围注射技术在乳腺癌前哨淋巴结显像术中检测内部乳腺淋巴结引流的能力。在手术当天进行四次5至10 MBq(0.14-0.27 mCi)Tc-99m锑硫胶体注射,然后进行按摩和成像。将放射性同位素悬浮在0.5 mL气闸中的0.1 mL中。每次注射都是用25号针在1.1至1.3厘米深度下进行2秒钟。无法检索记录或除了乳晕周围或肿瘤周围进行了注射技术的患者均从分析中剔除。
结果:133例患者接受了乳晕治疗,72例患者接受了肿瘤周围治疗,36例患者被排除在分析之外。 133例患者中有24例(18.0%)出现了内部乳腺引流,其中12例(9%)仅见于内部乳腺链。这比以前的研究(引用0.0%至4.3%)要高得多,并且与先前报道的使用肿瘤周围技术的比率相似。
结论:我们使用Tc-99m锑硫胶体的乳晕周围注射技术能够检测至少18.0%的患者的内部乳腺淋巴结。

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