Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers
Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers
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DOI：
10.1016/s0001-2998(97)80036-0
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发表时间：
1997-01-01
影响因子：
4.9
通讯作者：
Taylor, AT
中科院分区：
文献类型：
--
作者：
Alazraki, NP;Eshima, D;Taylor, AT
由于对前哨淋巴结概念的关注以及手术室中可用于定位放射性标记前哨淋巴结的外科伽马探针的可用性，淋巴结造影术的兴趣重新抬头。黑色素瘤的常规手术管理已被改变用于中等厚度肿瘤，使得仅当前哨淋巴结在伽马探针引导切除后的组织学检查中为肿瘤阳性时才对淋巴结床进行淋巴结清扫。这种方法是成本效益，节省约80%的这些患者（前哨淋巴结肿瘤阴性）的成本和不必要的“选择性淋巴结清扫的发病率。此外，活检可以在所有接受肿瘤部位淋巴引流的淋巴结床上进行，从而通过提供最合适的治疗来改善分期和生存率。大量的工作已经完成，以开发最佳的成像技术和最好的放射性药物制备，以实现准确的，可重复的淋巴引流图像。我们的方法包括以下皮内注射锝99 m硫胶体（改良制剂），然后进行动态成像（每帧10秒）;静态成像长达30分钟，后期成像1至2小时。图像显示淋巴通道，导致前哨淋巴结在1，2，3，或更多的解剖位置。手术管理被改变，包括采样前哨淋巴结的淋巴结床，其中许多将不会被以前的传统手术估计淋巴引流采样。虽然淋巴结造影术和术中探针定位前哨淋巴结在黑色素瘤中的临床成功是显而易见的，但淋巴结造影术和前哨淋巴结概念在乳腺癌中的应用是研究性的，但很有前途。将放射性药物注射到乳房肿瘤周围，然后进行成像以描绘淋巴引流到前哨淋巴结。放射性药物、注射物的体积和/或活性以及成像的最佳方法尚未确定。乳腺淋巴引流可以是腋窝、内乳和/或锁骨上淋巴结的任何组合。版权所有（C）1997 W.B.桑德斯公司
There is a resurgence of interest in lymphoscintigraphy because of attention to the sentinel node concept and the availability of the surgical gamma probe that can be used in the operating room to localize radiolabeled sentinel nodes. Conventional surgical management of melanoma has been altered for intermediate thickness tumors such that lymph node dissection is performed for a lymph node bed only if the sentinel node is tumor positive on histological exam after gamma probe-guided excision. This approach is cost effective, saving about 80% of these patients (sentinel node tumor negative) the cost and morbidity of unnecessary ''elective lymph node dissection.'' In addition, a biopsy can be performed on all lymph node beds that receive lymphatic drainage from the tumor site thereby improving staging and perhaps survival by providing the most appropriate therapy. Substantial work has been done to develop optimum imaging techniques and the best radiopharmaceutical preparation to achieve accurate, reproducible lymphatic drainage images. Our methodology includes the following intradermal injections of a technetium 99m sulfur colloid (modified preparation) are followed by dynamic imaging (10 seconds per frame); static imaging up to 30 minutes and late imaging at 1 to 2 hours. Images show lymphatic channels that lead to sentinel nodes in 1, 2, 3, or more anatomic locations. Surgical management is altered to include sampling sentinel nodes of nodal beds, many of which would not have been sampled by previous conventional surgical estimates of lymphatic drainage. While clinical success of lymphoscintigraphy and intraoperative probe localization of the sentinel node in melanoma is evident, use of lymphoscintigraphy and the sentinel node concept in breast cancer is investigative, but promising. The radiopharmaceutical is injected around the tumor in the breast followed by imaging to delineate lymphatic drainage to the sentinel node(s). Optimum methodologies for radiopharmaceutical, volume and/or activity of injectate, and imaging have yet to be determined. Breast lymphatic drainage can be to axilla, internal mammary, and/or supraclavicular nodes in any combination. Copyright (C) 1997 by W.B. Saunders Company.