The Study On The Potential Clinical Value Of Internal Mammary Sentinel Nodes Radioisotope Imaging In The Radiation Target Volume Design Of Internal Mammary Nodes After Breast Cancer Surgery

Partâ… .The study of ⁹⁹T_c^m-sulphur colloidal particles' propertiesPurpose The ⁹⁹T_c^m-sulphur colloid was obtained from a given reagent kit and labeling procedure.This study was to investigate the colloidal particles' diameter, distribution,stability and the effect of physiological salt solution on its properties using Transmission Electron Microscope(TEM).Materials and Methods The boiling time was kept as 2 minutes during the labeling procedure.Took 100ul from surface and bottom liquid respectively as soon as the ⁹⁹T_c^m-sulphur colloid was done, then the two samples were performed respectively as follows:1) Spotted 10ul liquid on the carbon supported membrane,then observed its diameter,shape and distribution via TEM.2) Diluted the rest liquid with normal saline to make it clear, then sampled,spotted and observed it by TEM.3) Analyzed the difference of surface colloidal particles' properties between diluted and undiluted liquid,as well as that of bottom liquid.4) Repeat above-mentioned procedures on 30min and from 1h to 6h at 1h' intervals,observed the stability of the particles' properties.Results 1) Within 2 hours,the colloidal particles showed global graininess with a diameter of 10nm round about.In the third hour,the particles appeared a tendency to aggregation and also a minority of particles with a diameter of 25～50nm came out. Since the 4th hour,the diameter of some particles reached 100～300nm,and the dendritic sediments with vivid venations came into being gradually.2) The surface colloidal particles' properties didn't differentiate within 2 hours,neither did the bottom ones.From the third hour,the bottom particles were more apt to get together than the surface particles.3) The properties of diluted and undiluted liquid didn't show essential differences.Conclusions This colloidal tracer's diameter,shape and distribution remain stable in 3 hours on the whole.The particles' properties won't be changed if the tracer is diluted with normal saline but used immediately. Partâ…¡.The analysis of factors affecting ⁹⁹T_c^m-sulphur colloid internal mammary sentinel nodes lymphoscintigraphyPurpose To study the possible influential factors in ⁹⁹T_c^m-sulphur colloid internal mammary sentinel nodes(IMSNs) lymphoscintigraphy.Materials and Methods The IMSNs lymphoscintigraphy data of 263 breast cancer patients(T1 or T2) were reviewed.8 variables including patients' age,left or right breast,various quadrants, tumor size,o'clock site of injection around tumor,injection volume,injection radioactivity and delay time of imaging were selected as influential factors to be analyzed by single factor and multifactor analysis of SPSS11.5,significant value is 0.05.Results Of the 8 variables,left or right breast,various quadrants,injection site,injection volume and radioactivity are all independent factors affecting IMSNs lymphoscintigraphy(P＜0.05),while age,tumor size and delay time are not of statistical significance(P＞0.05).Conclusions Left breast and inner half breast are easier to drain to internal mammary nodes(IMNs) than right breast and outer half breast respectively(P=0,0.011).Three sites' injection around tumor is better than four sites' injection(P=0.001).0.5ml per site group is more efficient than other groups.Radioactivity doesn't play a key role in the radioactivity/volume combination.Partâ…¢.The clinical study on the relations between injection pressure and internal mammary sentinel nodes lymphoscintigraphyPurpose To find the relations between the local tissue tension during injection and IMSN lymphoscintigraphy,thereby get the most suitable injection volume to optimize the imaging efficiency,then realize the individual injection.Materials and Methods 1) The focus should locate in the lower inner quarter or lower outer quarter of left breast,abutting on 1cm under areola.The injection method was selected as deep injection around the focus with the injection site of 1cm under areola.2) Monitored the real time changes of local tissue tension during the injection by PSA4-102GP pressure switch and performed imaging via GE Millennium VG SPECT/CT.3)Graded the breasts as large,moderate and small according to the standard of female brassiere size.Analyzed the effect of injection pressure and breast size on the imaging rate and imaging time.Results 1) Selected the breast size as the object.The small breasts were easier to get positive imaging results than the moderate and large ones.The same injection volume would produce a higher average tissue tension in small breasts than in the others.2)Selected the breast density as the object.Using 0.5ml as the injection volume,the high density breast was apt to get a high tissue tension and then a high IMSNs imaging rate.75%of the high density breasts and 60%of the moderate ones could get positive IMSN lymphoscintigraphy, however,the latters needed more time than the formers did.The tissue tension decreased obviously in low density breasts with an injection volume of 0.5ml,but the IMSNs still occurred for a possible reason of a small size and a relative more abundant lymphatic vessels.Conclusions Breast density is the key factor in the IMSN lymphoscintigraphy.Increasing the injection volume according to the breast density to gain an appropriate tissue tension will help to promote the imaging rate and shorten the imaging time.And also,the smaller the breast is,the higher the IMSNs imaging rate is.Partâ…£.The study on the potential clinical value of internal mammary sentinel nodes radioisotope imaging in the radiation target volume design of internal mammary nodes after breast cancer surgeryPurpose The locations of IMNs differ quite among individuals.This study is to promote the individual IMN radiation field design via IMSNs lymphoscintigraphy by GE Millennium VG SPECT/CT.Materials and Methods 1) ⁹⁹Tc^m-SC was chosen as the radioactive tracer.40 breast cancer patients were ordered SPECT/CT IMSN lymphoscintigraphy.The depth and lateral distance(the width between the IMN and the mid-sternal line) of each IMN were measured and then were compared with the present standard IMN radiation field.2) Collected and analyzed the formentioned patients' PET/enhanced CT images.Selected the same reference points in the enhanced CT and SPECT/CT images and measured their depths or widths,then compared them in order to evaluate the location accuracy of the latter equipment. Results 1) 70 IMNs were imaged.The depth was 1.10～3.99cm with the average of 2.15cm.The lateral distance was 1.52～6.59cm with the average of 4.37cm.The difference of depth between left and right IMNs was of no significance,neither was the width.Only 11.4%(8/70)of the IMNs and 10%(4/40)of the patients could fit the routine field.2) SPECT/CT is believable for the localization of IMNs since its measurements were quite close to those of diagnostic CT.Conclusions The radiation field should be designed individually by IMSN lymphoscintigraphy so that the curative effect could be optimized while the side effect could be minimized.