Prospective comparison of 3 gamma-probes for sentinel lymph node detection in 200 breast cancer patients.
Prospective comparison of 3 gamma-probes for sentinel lymph node detection in 200 breast cancer patients.
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发表时间：
2005-03
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通讯作者：
J. Classe;M. Fiche;C. Rousseau;C. Sagan;F. Dravet;R. Pioud;A. Lisbona;L. Ferrer;L. Campion;I. Resche;C. Curtet
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作者：
J. Classe;M. Fiche;C. Rousseau;C. Sagan;F. Dravet;R. Pioud;A. Lisbona;L. Ferrer;L. Campion;I. Resche;C. Curtet
以前的报道表明，腋窝前哨淋巴结（ASLN）放射检测可以对早期乳腺癌患者进行准确的腋窝分期。放射导向手术意味着使用伽马探针对标记的ASLN的放射性进行计数。几种伽马探针是市售的，每种都有自己的特性。用于ASLN放射性检测的γ探头类型的临床影响仍有待评估。方法评价了三种市售γ探针：含锗酸铋晶体的闪烁体（探针A）、含碲化镉晶体的半导体（探针B）和含碲化锌镉晶体的半导体（探针C）。200例早期乳腺癌患者前瞻性入选接受ASLN放射检测和腋窝淋巴结清扫术。ASLN定位包括在肿瘤周围注射（99 m）Tc-硫胶体。对于每例患者，前哨淋巴结连续计数与3个探针和每个γ-探针的灵敏度确定从ASLN残留活性。比较各探针的检出率和假阴性率。结果ASLN平均残留活性为52 kBq（范围0.07 ~ 189 kBq）。比较了3种探针的灵敏度，发现探针A的灵敏度最高。探针A的检出率明显高于探针B（93%vs.86%，P = 0.05），但与探针C（93%vs.90%）无显著性差异。在3种探针之间未观察到假阴性率差异。结论ASLN的检出率取决于所用γ探针的类型。由于未能检测到ASLN导致完全腋窝淋巴结切除术，涉及局部发病率和其他后遗症，γ探针的类型必须被认为是重要的前哨淋巴结放射检测。
UNLABELLED Previous reports have shown that axillary sentinel lymph node (ASLN) radiodetection allows accurate axillary staging for patients with early breast cancer. Radioguided surgery implies the use of a gamma-probe to count the emitted radioactivity of marked ASLNs. Several gamma-probes are commercially available, each with its own properties. The clinical impact of the type of gamma-probe used for ASLN radiodetection remains to be evaluated. METHODS Three commercially available gamma-probes were evaluated: a scintillator with a bismuth germanate crystal (probe A), a semiconductor with a cadmium telluride crystal (probe B), and a semiconductor with a cadmium zinc telluride crystal (probe C). Two hundred patients with early breast cancer were prospectively enrolled to undergo ASLN radiodetection and axillary lymphadenectomy. ASLN mapping consisted of injecting (99m)Tc-sulfur-colloid around the tumor. For each patient, sentinel lymph nodes were counted successively with the 3 probes and the sensitivity of each gamma-probe was determined from ASLN residual activity. The results of detection rates and false-negative rates for each probe were compared. RESULTS Mean residual ASLN activity was 52 kBq (range, 0.07-189 kBq). Sensitivity was compared among the 3 probes and found to be best for probe A. The detection rate of probe A was significantly better than that of probe B (93% vs. 86%, P = 0.05) but not different from that of probe C (93% vs. 90%). No differences in false-negative rates were observed among the 3 probes. CONCLUSION ASLN detection rate depends on the type of gamma-probe used. Because failure to detect the ASLN leads to complete axillary lymphadenectomy, involving local morbidity and other sequelae, the type of gamma-probe must be considered important for sentinel lymph node radiodetection.