The Study Of ～(99m)Tc-sulfur Colloid On Sentinel Lymph Node Detection And Ultrasonography In Early Stage Breast Cancer Patients

Objectives:To evaluate the clinical feasibility and value of the combination of ^99mTc-sulfur colloid(^99mTc-SC)on sentinel lymph node(SLN)imaging with gamma probe SLN detection and ultrasonography in patients with early-stage breast cancer.Methods:Thirty-nine women with early-stage breast cancer were diagnosed by mammography,ultrasonography or needle biopsy(T₁,15;T₂,24;mean age,49.38±9.86 years; range,32-67years).The histological diagnosis of the primary tumor was invasive ductal carcinoma in 29 patients,invasive lobular carcinoma in 4 patients,mucinous adenocarcinoma in 3 patients,intraductal carcinoma in 2 patients and carcinoma simplex in 1 patient.In the afternoon before the operation,111MBq-185MBq(1ml-2ml)^99mTc-SC was injected the sub cutis around the tumor at the 3,6,9,and 12 o'clock positions in all patients,static images were taken at 10min,30min,1h,1.5h,2h until the SLN was visualized.Subsequently,patients were underwent ultrasonography.The next day,patients were taken to the operating room,aided by gamma probe SLN detection was done during the operation.Results:In 38/39 patients(97.44%),SLNs were detected with ^99mTc-SC lymphoscintigraphy. With the application of intraoperative gamma probe,SLNs were detected in 37/39 patients (94.87%),correlate rate was 92.1%.Ultrasonography demonstrated SLN tumefaction in 20 of 39 patients(51.3%)whose SLNs were visualized,the SLNs included metastatic tumor deposits in 14/39 patients(35.9%),there were metastasis in non SLNs in 8/14 patients(57.1%).There was a correlation between non SLNs metastasis and primary tumor which more than 2cm(P＜0.05), and metastasis rate was 72.7%.Additionally,in one patient(2.56%),axillary lymph node was skip metastasis(metastasis was not observed in the SLN,other axillary lymph nodes were metastasis).Through analysis of the ROC curve,the areas of the transverse diameter, longitudinal diameter and L/B(the ratio of the longitudinal and transverse diameter)in axillary lymph nodes were 0.821,0.798,0.728 respectively(P＜0.05).The transverse and longitudinal diameter of the metastatic lymph nodes were more than 0.6cm and 0.8cm,1.0≤L/B＜2.2.The sensitivity,specificity,accuracy,false negative and misdiagnosis of the combination of ^99mTc -SC on SLN identification with ultrasonography in patients was 93.33%,91.67%,92.3%,6.67% and 8.33%respectively.Conclusions:1.^99mTc-SC has a better rate of detection and guide value in SLN detection of the early-stage breast cancer.2.It is an effective and exact method to combinate ^99mTc -SC SLN detection by lymphoscintigraphy with intraoperative gamma probe application and ultrasonography in determing earlier SLN and non SLN metastasis in breast cancer patients.