Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

Camparison between the 1 Day and the 2 Day Protocols of Lymphoscintigraphy and Sentinel Node Biopsy using Subareolar Injection in Breast Cancer Patients: A Retrospective Study

유륜하 주사에 의한 유방암 환자의 전초림프절 스캔과 전초림프절 생검에 있어서 당일검사와 전날검사의 비교: 후향적 연구

  • Seok, Ju-Won (Department of Nuclear Medicine, College of Medicine, Chung-Ang University) ;
  • Jun, Sung-Min (Department of Nuclear Medicine, College of Medicine, Pusan National University) ;
  • Nam, Hyun-Yeol (Department of Nuclear Medicine, College of Medicine, Pusan National University) ;
  • Kim, In-Ju (Department of Nuclear Medicine, College of Medicine, Pusan National University)
  • 석주원 (중앙대학교병원 핵의학과) ;
  • 전성민 (부산대학교병원 핵의학과) ;
  • 남현열 (부산대학교병원 핵의학과) ;
  • 김인주 (부산대학교병원 핵의학과)
  • Published : 2009.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Lymphoscintigraphy and sentinel node biopsy are used in detection of axillary lymph node metastasis in breast cancer patients, but standardized technique is not established. We compared the results of the injection the morning of surgery (1 day protocol) with the subareolar injection the day before surgery (2 day protocol) with the subareolar injection in patients with breast cancer having lymphoscintigraphy and sentinel node biopsy. Materials and Methods: This study included 349 patients who underwent the breast cancer operation during 2001-2004. One hundred seventy one patients (1 day protocol, 1 hour) was injected 0.8ml of Tc-99m Tin-Colloid (37 MBq) by subareolar injection on the morning of surgery. One hundred seventy eight patients (2 day protocol, 16 hour) was injected 0.8 ml of T c-99m Tin-Colloid (185 MBq) on the afternoon before surgery. Lymphoscintigraphy was performed in sitting position and sentinel node localization was performed by hand-held gamma probe during operation. Result: In the 1 day protocol, 153 cases (89.5%) of the sentinel node were localized by lymphoscintigraphy and 150 cases (87.7%) were localized by gamma probe. In the 2 day protocol, 159 cases (89.3%) were localized by lymphoscintigraphy and 154 cases (86.5%) were localized by gamma probe. There was no significant difference in localization of sentinel node between the 1 day and the 2 day protocol by lymphoscintigraphy and gamma probe (p>0.05, p>0.05). Conclusion: There was no difference the result of localization of sentinel node with subareolar injection between the 1 day and the 2 day protocol in breast cancer patients. Because the 2 day protocol allows the enough time of performing lymphoscintigraphy, it is more useful in localization of sentinel node in breast cancer patients.

목적: 전초림프절 스캔과 전초림프절 생검은 유방암 환자에서 액와림프절 전이를 인지하기 위해서 사용되지만, 표준화된 방법이 마련되어 있지 않다. 액와림프절 전이를 인지하기 위한 전초림프절 검사에 있어서 본 연구에서는 수술당일 주사하는 당일검사와 수술전날 주사하는 전날검사의 결과를 비교하여 보았다. 대상 및 방법: 본 연구에서는 2001년에서 2004년사이에 유방암으로 수술을 시행했던 349명의 환자를 대상으로 하였다. 171명의 환자는 Tc-99m Tin-Colloid (37 MBq) 0.8 ml를 유륜하로 수술당일(1시간 전)에 주사하였다. 178명의 환자는 Tc-99m Tin-Colloid (185 MBq) 0.8 ml를 유륜하로 수술전날(16시간 전)에 주사하였다. 앉은 자세에서 림프신티그라피가 시행되었고, 수술 중에 감마프로브로 전초림프절을 발견하였다. 결과: 당일검사를 시행한 전체 171명의 환자 중에서 153명(89.5%)이 림프신티그라피에 의해 전초림프절이 발견되었고, 150명(87.7%)이 감마프로브에 의해 전초림프절이 발견되었다. 전날검사를 시행한 전체 178명의 환자 중에서 159명(89.3%)이 림프신티그라피에 의해 전초림프절이 발견되었고, 154명(86.5%)이 감마프로브에 의해 전초림프절이 발견되었다. 당일검사와 전날검사에 있어서, 림프신티그라피와 감마프로브에 의한 전초림프절 발견율의 유의한 차이는 없었다(p>0.05, p>0.05). 결론 : 유방암 환자에서 전초림프절을 발견하는데 있어 당일검사와 전날검사에 의한 차이는 없었다. 전날검사는 전초림프절 스캔을 시행할 충분한 시간을 얻을 수가 있어서, 유방암 환자에서 전초림프절을 발견하는데 더 유용할 것이다.

Keywords

References

  1. Van der Wall E. The sentinel node in breast cancer: implications for adjuvant treatment? Eur J Nucl Med 1999;26(suppl):s17-9 https://doi.org/10.1007/s002590050573
  2. Morrow M. Role of axillary dissection in breast cancer managemnet. Ann Surg Oncol 1996;3:233-4 https://doi.org/10.1007/BF02306276
  3. Cascinelli N, Greco M, Bufalino R, Clemente C, Galluzzo D, delle Donne V, et al. Prognosis of breast cancer with axillary lymph node metastases after surgical treatment only. Eur J Cncer Gin Oncol 1987;23:795-9 https://doi.org/10.1016/0277-5379(87)90281-1
  4. Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphedema after the treatment of the breast cancer. Br J Surg 1986;73:580-4 https://doi.org/10.1002/bjs.1800730723
  5. Tiourina T, Arends B, Huysmans D, Rutten H, Lemaire B, Muller S. Evaluation of surgical gamma probes for radioguided sentinel node localization. Eur J Nucl Med 1998;25:1224-31 https://doi.org/10.1007/s002590050288
  6. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977;39:456-66 https://doi.org/10.1002/1097-0142(197702)39:2<456::AID-CNCR2820390214>3.0.CO;2-I
  7. Morton DL, Wen DR, Wong JH. Technical detail of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392-9 https://doi.org/10.1001/archsurg.1992.01420040034005
  8. Klag DN, Weaver DL, Alex JC. Surgical resection and radiolocalization of the sentinel node in breast cancer using gamma probe. Surg Oncol 1993;2:335-40 https://doi.org/10.1016/0960-7404(93)90064-6
  9. Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Gin Oncol 1997;15:2345-50 https://doi.org/10.1200/JCO.1997.15.6.2345
  10. Krag D. Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer-a multicenter validation study. N Eng J Med 1998;339:941-6 https://doi.org/10.1056/NEJM199810013391401
  11. D'Eredita G, Giardina C, Guerriery AM, Berardi T. A further validation of subareolar injection technique for breast sentinel lymph node biopsy. Ann Surg Oncol 2006;13:701-7 https://doi.org/10.1245/ASO.2006.04.027
  12. Peley G, Sinkovies I, Toth J, Farkas E, Keresztes S, Koves I. Subareolar injection of radioactive colloid for sentinel lymph node identification in breast cancer patients. Am Surg 2004;70:625-9
  13. Maza S, Thomas A, Winzer KJ, Huttner C, Blohmer JU, Jauschild M, et al. Subareolar injection of technetium-99m nanocolloid yields reliable data on the axillary lymph node tumour status in breast cancer patients with previous manipulations on the primary tumour: a prospective study of 117 patients. Bur J Nucl Med Mol Imaging 2004;31:671-5 https://doi.org/10.1007/s00259-003-1447-z
  14. D'Eredita G. Ferrarese F, Cecere V, Massa ST, de Came F, Fabiano G. Subareolar injection may be more accurate than other techniques for sentinel lymph node biopsy in breast cancer. Ann Surg OncoI 2003:10:942-7 https://doi.org/10.1245/ASO.2003.01.022
  15. McCarter MD, Yeung H, Yeh S, Fey J, Borgen PI, Cody HS $3^{nd} $Localization of the sentinel node in breast cancer: identical results with same-day and day-before isotope injection. Ann Surg Oncol 2001;8:682-6 https://doi.org/10.1007/s10434-001-0682-4
  16. Koizumi M, Nomura E, Yamada T, Takiguchi T, Tanaka K, Yoshimoto M, et al. Sentinel node detection using $^{99m}Tc-rhenium$ sulphide colloid in breast cancer patients: evaluation of 1 day and 2 day protocols, and a dose-finding study. Nucl Med Commun 2003;24:663-70 https://doi.org/10.1097/00006231-200306000-00008
  17. Yeung HW, Cody III HS, Turlakow A, Riedel ER, Fey J, Gonen M, et al. Lymphoscintigraphy and sentinel node localization in breast cancer patients: a comparison between 1-day and 2-day protocols. J Nucl Med 2001;42:420-3
  18. Gutman F, Sanson A, Piquenot JM, Hitzel A, Ladonne JM, Dessogne P, et al. Intra-individual comparison of sentinel lymph node scintigraphy on the day of injection and on the following day in breast cancer. Nucl Med Commun 2006;27:5-9 https://doi.org/10.1097/01.mnm.0000189781.62282.0d