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Lymphoscintigraphy Combine Staining in Diagnose of Internal Mammary Sentinel Lymph Nodes of Breast Cancer: A Pilot Clinical Study

Author: ZhangZaiHong
Tutor: JiangJun
School: Third Military Medical University
Course: Surgery
Keywords: Breast tumor Internal mammary lymph nodes Sentinel lymph node
CLC: R737.9
Type: Master's thesis
Year: 2011
Downloads: 16
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Abstract

Pathological state of internal mammary lymph nodes in breast cancer is second only to axillary lymph nodes are independent prognostic factors. Internal mammary lymph node and axillary lymph nodes as part of the first leg of the breast lymphatic drainage, and internal mammary lymph node metastasis or axillary lymph node metastasis has a similar prognosis negative for both patients a better prognosis than any single regional lymph node-positive patients, and both have transferred the patients with the worst prognosis. Studies have shown that breast primary tumor resection, residual tumor cells in the internal mammary lymph nodes may become a source of future recurrence and metastasis. Clear internal mammary lymph node biopsy accurately determine breast cancer clinical staging, individualized treatment and patient prognosis has important value. Breast cancer extended radical mastectomy for us to grasp the first hand information of the internal mammary lymph node metastases in breast cancer. But with the advances in the development of breast cancer biology theory and systemic therapy and radiation therapy, breast cancer surgery presented a narrowing trend. Abandoned breast extended radical surgery, clinical lack of simple, secure access to internal mammary lymph nodes, surgical methods, it is difficult to determine the pathological state of internal mammary lymph nodes. The endoscopic technology new clinical technology appeared in the late 1990s, the introduction into the breast of the internal mammary lymph node resection is a theory and technology innovation. But its efficacy and the traditional extended radical mastectomy compared how has not been reported. At the same time, the internal mammary lymph nodes in breast cancer detection methods reported different clinical value of the existence of internal mammary sentinel lymph node biopsy has been controversial. This topic intends to conduct a preliminary study on the above issues. Experimental methods and main results of endoscopic and open surgical resection comparison of internal mammary lymph chain in breast cancer research method: Take from June 2004 to November 2010 at the undergraduate hospitalized diagnosed with breast cancer and internal mammary lymph node metastasis in high-risk patients total of 97 cases, including 50 cases of breast cancer modified radical endoscopic internal mammary lymph chain resection (laparoscopy group), 47 patients of breast cancer expanded or improved extended radical mastectomy (open group). Record two surgical operative time, blood loss, clear the internal mammary lymph nodes, postoperative drainage time, postoperative recovery time, postoperative VAS pain scores, postoperative complications indicators and compared in order to explore more suitable for the internal mammary lymph node metastasis in breast cancer patients at high risk of surgical approach. Results: 97 patients enrolled were successfully completed surgery, no organ damage and postoperative bleeding and other serious complications. Laparoscopy group after 72 h VAS pain scores were lower than in the open group (Z = 2.26, P = 0.02). Two groups of operative time, blood loss, clear the internal mammary lymph nodes, postoperative drainage time, postoperative recovery time, 24 h after the pain score and complications of comparison, the difference was not statistically significance (P gt; 0.05 ). Were followed up for 6 to 15 months, with a median follow-up of 12 months, into the group of patients had no recurrence, distant metastasis or death. 2. Comparative study of methods of internal mammary sentinel lymph node in breast cancer detection methods: through review by the Ethics Committee of the Third Military Medical University Southwest Hospital, taken from December 2008 to May 2011 in the undergraduate hospitalized diagnosed as breast cancer and internal mammary lymph node metastasis risk of 51 patients. Randomly divided into two groups, radionuclide carbon nanoparticles group of 25 patients; radionuclide the Meilan group 26 cases. Radionuclide scintigraphy in the preoperative, intraoperative gamma detector probe initially identified the position of the internal mammary sentinel lymph node, respectively, as the intraoperative use of the nanometer carbon or Meilan tracer. Then the implementation of breast modified radical laparoscopic excision or breast milk lymphatic chain expanded or improved extended radical mastectomy. Comparative analysis of two combined assay the the breast internal mammary sentinel lymph node differences, in order to explore more effective detection of the internal mammary lymph nodes in breast cancer; pathologic results of the statistical analysis, to explore the breast whether the existence within the mammary sentinel lymph node and its biopsy The clinical value. Results: carbon nanoparticles group detecting internal mammary sentinel lymph node in breast cancer-positive rate was 80.0% (20/25), Meilan group to detect breast cancer internal mammary sentinel lymph node-positive rate of 73.1% (19/26), the two groups combined method to detect breast cancer internal mammary sentinel lymph node was no significant difference (P gt; 0.05), but the staining effect of nano carbon significantly better than Meilan. The combined method of detecting internal mammary sentinel lymph node in breast cancer detection rate was 76.5% (39/51), in which the internal mammary sentinel lymph node metastasis-positive patients with 20 cases, accounting for 39.2% (20/51). Sentinel lymph node metastasis-positive patients, including milk, is just the internal mammary sentinel lymph node metastasis, rather than the sentinel lymph node-negative patients with 12 cases, accounting for 23.5% (12/51), the internal mammary sentinel lymph node and non-sentinel lymph node cancer transfer of the eight cases were positive patients, accounting for 15.7% (8/51). United assay out internal mammary sentinel lymph nodes of patients with internal mammary sentinel lymph nodes with non-outposts are pathological examination without metastasis (negative) in 19 cases, accounting for 37.3% (19/51). The combined method of detecting internal mammary sentinel lymph nodes were not detected in 12 patients, 23.5% (12/51). Which pathologically confirmed pathological examination of nine cases (17.6%, 9/51) were not found to have internal mammary metastasis have internal mammary lymph nodes. By the internal mammary lymph node dissection carefully to find the various intercostal internal mammary lymph nodes were not found among the three cases, accounting for 5.9% (3/51). No internal mammary sentinel lymph node negative rather than the sentinel lymph node metastasis cases. Conclusion 1. Breast modified radical postoperative endoscopic downlink internal mammary lymph chain resection is feasible and safe, less invasive, and the effect is not inferior to the extended radical mastectomy in breast cancer. 2 nucleinotherapy joint carbon nanoparticles reliable detection method of internal mammary sentinel lymph node in breast cancer, intraoperative gamma detector is effective preoperative examination supplement also help to reduce the difficulty of the surgery is surgery. Mammary lymphatic pathway exists. Breast sentinel lymph nodes, the internal mammary SLN pathological state to accurately reflect the pathological situation of internal mammary lymph chain breast, internal mammary lymph node biopsy in breast cancer surgery can be used as to determine whether the internal mammary lymph chain cleaning basis.

Lymphoscintigraphy Combine Staining in Diagnose of Internal Mammary Sentinel Lymph Nodes of Breast Cancer: A Pilot Clinical Study

Abstract

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