Clinical Evaluation of 99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients
Clinical Evaluation of 99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients
复制标题
Tc-99m-利妥昔单抗用于乳腺癌患者前哨淋巴结定位的临床评价
DOI：
10.2967/jnumed.115.160572
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发表时间：
2016-08-01
影响因子：
9.3
通讯作者：
Yang, Zhi
中科院分区：
文献类型：
--
作者：
Li, Nan;Wang, Xuejuan;Yang, Zhi
前哨淋巴结（SLNs）转移状态可能是乳腺癌最重要的预后因素。在本文中，我们报告我们所知的第一项研究Tc-99 m-rituximab作为放射性示踪剂的前哨淋巴结成像使用淋巴结造影术在术前和术中乳腺癌患者。方法：以淋巴结中广泛表达的CD 20抗原为靶点，设计了Tc-99 m-rituximab作为SLN示踪剂。对2,317例接受淋巴结造影和前哨淋巴结活检（SLNB）的原发性乳腺癌患者进行了回顾性研究。在成像之前，所有患者术前瘤周注射37 MBq的Tc-99 m-rituximab。结果如下：Tc-99 m-rituximab的合成具有高放射性标记产率和高放射化学纯度（>95%），分子完整性和免疫活性保持良好。对100例乳腺癌患者进行的初步研究表明，与SLNB比较，~（99）Tc-利妥昔单抗SLN淋巴结造影的成功率为100%，敏感性为97.4%，特异性为100%，准确性为98.0%，假阴性率为2.60%。在2,217例患者中，淋巴管造影和SLNB的成功率分别为98.8%和99.9%，SLN平均数分别为1.78（范围：1-10）和2.85（范围：1-15）。年龄是淋巴结造影和术中手持Upsilon探针识别SLN数量的独立预测因素（P < 0.05），而其他因素如性别、成像时间、原发肿瘤部位、组织病理学亚型、临床T分期和免疫化学则不是（P > 0.05）。但不同病理类型、临床T分期和免疫组化的SLN转移率不同（P
The metastatic status of sentinel lymph nodes (SLNs) might be the most important prognostic factor in breast cancer. In this paper, we report to our knowledge the first study of Tc-99m-rituximab as a radiotracer for imaging of SLNs using lymphoscintigraphy in both preoperative and intraoperative breast cancer patients. Methods: Tc-99m-rituximab was designed as an SLN tracer targeting the CD20 antigen, which expresses extensively in LNs. A retrospective study was performed on 2,317 patients with primary breast cancer who underwent lymphoscintigraphy and sentinel lymph node biopsy (SLNB). Before imaging, all patients were administered a preoperative peritumoral injection of 37 MBq of Tc-99m-rituximab. Results: Tc-99m-rituximab was synthesized in both high radiolabeling yield and high radiochemical purity (>95%), with molecular integrity and immune activity well maintained. The initial study of 100 breast cancer patients showed that the success rate of SLN lymphoscintigraphy by injection of Tc-99m-rituximab, as compared with SLNB, was 100%, and the sensitivity, specificity, accuracy, and false negative rate were 97.4%, 100%, 98.0%, and 2.60%, respectively. Of the following 2,217 patients studied, the success rate of lymphoscintigraphy and SLNB was 98.8% and 99.9%, and the average number of SLN was 1.78 (range, 1-10) and 2.85 (range, 1-15). Age was an independent predictor of the number of SLNs identified by lymphoscintigraphy and intraoperative handheld Upsilon-probe (P < 0.05), and other factors-such as sex, imaging time, primary tumor site, histopathologic subtype, clinical T stage, and immunochemistry-were not (P > 0.05). However, the SLN metastatic rates were different in patients with different histopathologic subtype, clinical T stage, and immunochemistry (P