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目的:探讨~(99m)Tc-硫胶体(sulfur colloid,SC)用于早期乳腺癌前哨淋巴结(sentinel lymph node,SLN)活检术的最适注射体积。方法:选择原发性乳腺癌(T_(1~2)N_0M_0)、乳房为中小型-致密型患者150例,按~(99m)Tc-SC注射体积不同分为0.5、1、1.5 mL 3组(每组n=50),术前1 d瘤周深部两点法注射(37 MBq/点),2 h后SPECT显像。比较3组患者腋窝SLN(axillary SLN,ASLN)及内乳SLN(internal mammary SLN,IM-SLN)显像检出率。结果:各组总检出率、ASLN检出率和IM-SLN检出率分别为:96%(48/50)、94%(47/50)、74%(37/50),90%(45/50)、82%(41/50)、68%(34/50),52%(26/50)、32%(16/50)、18%(19/50)。总SLN和ASLN检出率在0.5 mL与1 mL组之间无统计学差异,但0.5 mL与1.5 mL组之间有统计学差异(P=0.001和0.004);IM-SLN检出率在0.5 mL组与其他两组之间有显著性差异(P<0.05)。各组注射疼痛评分分别为3.34±1.02、4.58±1.31和5.06±1.42,疼痛持续时间分别为(3.82±1.64)、(6.00±4.48)和(6.58±4.77)min。0.5 mL组疼痛评分、持续时间显著弱于其他两组(P<0.001)。结论:在中小型-致密型乳房患者中,示踪剂注射体积仅为0.5 mL/点即能获得较好的SLN检出率,且对定位IM-SLN有一定优势;同时小体积注射伴随较少的疼痛感,改善了患者舒适度。
Objective: To investigate the optimal injection volume of ~ (99m) Tc-sulfur colloid (SC) for biopsy of sentinel lymph node (SLN) in early stage of breast cancer. Methods: One hundred and fifty cases of primary breast cancer (T_ (1 ~ 2) N_0M_0) were selected. The breasts were divided into three groups (0.5,1,1.5 mL) according to the volume of ~ (99m) Tc- (N = 50 in each group). The tumor was injected deep two weeks before operation (37 MBq / point) and 2 h after SPECT imaging. The detection rates of axillary SLN (ASLN) and internal mammary SLN (IM-SLN) in the three groups were compared. Results: The overall detection rate, ASLN detection rate and IM-SLN detection rate were 96% (48/50), 94% (47/50), 74% (37/50), 90% 45/50), 82% (41/50), 68% (34/50), 52% (26/50), 32% (16/50), 18% (19/50). The detection rate of total SLN and ASLN was no significant difference between 0.5 mL and 1 mL groups, but there was a significant difference between 0.5 mL and 1.5 mL groups (P = 0.001 and 0.004). The detection rate of IM-SLN was 0.5 mL group and the other two groups were significantly different (P <0.05). The scores of pain in each group were 3.34 ± 1.02, 4.58 ± 1.31 and 5.06 ± 1.42, respectively. The duration of pain were (3.82 ± 1.64), (6.00 ± 4.48) and (6.58 ± 4.77) min respectively. 0.5 mL group pain score, duration was significantly weaker than the other two groups (P <0.001). CONCLUSIONS: In small to mid-size breast patients, tracer injection volume of only 0.5 mL / point can achieve a good detection rate of SLN, and has some advantages in locating IM-SLN. Less pain, improve patient comfort.