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