Vol.12, No 2, 2005 pp. 76 - 80
UC 616-006.6:616.428-076
SIGNIFICANCE OF SENTINEL LYMPH NODE
BIOPSY
LABELED BY
TECHNETIUM TC99M AND PATENT BLUE IN TREATMENT
OF PATIENTS WITH THE BREAST CANCER
Milan Višnjić1, Predrag Kovačević1,
Marina Vlajković2, Lidija Djordjević1,
Goran Djordjević1
1Clinic of Plastic and Reconstructive
Surgery, Clinical Center Niš
2Department of Nuclear Medicine,
Clinical
Center Niš
Summary. The major advance in breast cancer management is
sentinel
lymph node (SLN) localization and biopsy. The aim of the study was to
assess
the role of lymphatic mapping and gamma-probe guided lymph node biopsy
in breast cancer patients. Thirteen women (mean age 49 years) were
analysed.
Invasive ductal carcinoma was found in 62%, invasive lobular
carcinoma
in 15%, and ductal carcinoma in situ in 23%. A total of 0.3 ml (50 MBq)
of human albumine labeled by technetium 99m was injected intradermally
over the tumor. Dynamic lymphoscintigraphy was performed followed by
early
and late (16h) static scintigraphy. Blue dye (1%, 3 ml) was injected
around
the breast mass, 10 minutes before surgery. During the surgery, a gamma
probe was used to localize SLN. All SLNs were examined by frozen
section,
hematoxylin eosin staining and immunohistochemically. The success rate
of SLN identification was 100%. Six of the 13 patients (46%) had
metastatic
disease in the axilla. Of the 6 patients with metastases, the range of
involved nodes was from 1 to 3. The SLN(s) was positive in all patients
with metastatic disease (sensitivity: 100%), and thus there were no
skip
metastases (false negatives: 0%). The SLN was the only site of
metastases
in 4 of 6 patients (66%). Sentinel node biopsy is a highly accurate
method
for staging and treatment of breast cancer patients.
Key words: Breast cancer, sentinel lymph node, technetium Tc99m,
patent blue, biopsy
ZNAČAJ BIOPSIJE LIMFNIH ČVOROVA
STRAŽARA
OBELEŽENIH TEHNECIJUMOM I METILENSKIM PLAVIM
U TRETMANU PACIJENATA SA KARCINOMOM DOJKE
Kratak sadržaj: Veliki napredak u tretmanu karcinoma dojke je
lokalnizacija
i biopsija limfnog čvora stražara. Cilj rada je da se utvrdi značaj
limfnog
obeleđavanja i biopsije limfnog čvora vođene gama kamerom kod
pacijenata
sa karcinomom dojke. Ispitivano je trinaest žena (prosečne starosti 49
godina). Invazivni duktalni karcinom nađen je kod 62%, invazivni
lobularni
karcinom kod 15%, a duktalni karcinom in situ kod 23% pacijenata.
Intradermalno
iznad tumora je ubrizgana količina od 0,3ml (50 MBq) humanog albumina
obeleđenog
sa tehnecijumom Tc99m. Rađena je dinamska scintigrafija, a posle nje
rana
i kasna (16h) statična scintigrafija. Metil plavo (1%, 3 ml) je
ubrizgano
oko tumora dojke 10 minuta preoperacije. Tokom operacije je korištena
gama
kamera za loklaizaciju limfnog čvora strađara.Svi limfni čvorovi
strađari
su smrzavani i bojeni hematoksilin eoyin i imunohistohemijskom
tehnikom.
Uspešnost identifikacije limfnog čvora strađara je 100%, Šest od 13
pacijenata
(46%) je imalo metastaze u aksili. Od 6 pacijenata sa metastazama broj
poyitivnih limfnih čvorova bio je 1 do 3. Limfni čvor stražar je bio
pozitivan
kod svih pacijenata sa meatstazama (senzitivnost 100%). Tako da nije
bilo
metastaza koje su preskakale limfni čvor stražar (lažno negativno 0%).
Limfni čvor stražar je bio jedino mesto metastaze kod 4 od 6
pacijenata.(66%).
Biopsija limfnog čvora stražara je jako važan metod za određivanje
tradijuma
i za tretman pacijenata sa karcinomom dojke.
Ključne reči: Karcinom dojke, limfni čvor stražar, tehnecijum
Tc99m, metil plavo, biopsija
