| Part ⅠObjectiveTo compare the detection efficiency of 99mTc-Rituximab,which is a new tracer,with that of methylene blue and nanocarbon in sentinel lymph node（SLN）.The effect of neoadjuvant chemotherapy（NAC）on the detection efficiency of 99mTc-rituximab sentinel lymph nodes was also studied.MethodsA total of 107 female breast cancer patients were selected and randomly divided into two groups:59 cases in group A were injected with 99mTc-Rituximab 2-4 hours before the operation.The injection points were selected from 2 injection points on the surface of the tumor and in the surrounding glands or guided by ultrasound.Inject into the glands around the lower areola.For those who have undergone tumor resection,take 2 injection points in the skin and the surrounding glands on the surface next to the surgical incision.The blue dye tracer was injected into the subcutaneous tissue around the primary breast tumor or the subcutaneous tissue around the residual cavity wall after biopsy of the breast tumor at 4 points during the operation,a total of about 4 m L.A total of 48 patients in group B were injected with 99m Tc-Rituximab,which was self-labeled by our department,2-4 hours before the operation.The injection points were selected from 2 injection points in the skin of the tumor surface and in the surrounding glands or injected into the glands around the areola under ultrasound guidance.Patients undergoing tumor resection will take 2 injection points in the skin and surrounding glands on the surface of the surgical incision,and the nanocarbon suspension will be injected into the subcutaneous tissue surrounding the primary breast tumor at 4 points during the operation or the breast tumor resection biopsy the subcutaneous tissue around the wall of the residual cavity is about 0.4ml in total.All injection points were injected with 1 m L,and the total radioactivity was about 17.5-29.6MBq.All patients undergo a tomographic scan within 1-3 hours after the injection,and then use a gamma detector to detect"hot spots"during the operation,determine and take out the SLN for pathological examination.Compare the detection efficiency of different imaging agents SLNB,and evaluate the influence of NAC on the detection efficiency of SLN.Results1.Comparison of the detection rate of three different tracers:the detection rate of SLN guided by 99m Tc-Rituximab was 98.13%（105/107）,the detection rate of SLN guided by nanocarbon was 83.33%（40/48）,the United States The detection rate of blue staining method was 72.88%（43/59）.The difference in the detection rates of the three tracers was statistically significant（P=0.000<0.05）.The detection rate of SLN guided by 99m Tc-Rituximab was significantly higher than that of the other two groups;the nanocarbon suspension group was the second,the United States The blue group is the lowest.2.Comparison of the number of lymph nodes detected by the three tracers:a total of 259 hot lymph nodes were detected,with an average of 2.42;154 black-stained lymph nodes,with an average of 3.2;and 164 blue-stained lymph nodes,with an average of 2.27.2.3 Comparison of the number of lymph nodes between NAC treatment and no NAC treatment:A total of 86 lymph nodes were detected in the NAC group,with an average of 2.4,and a total of 110 lymph nodes were detected in the control group,with an average of 2.44.There was no significant difference in the average number of lymph nodes detected between the two groups（P=0.608>0.05）.Conclusion1.99m Tc-Rituximab guide breast cancer SLNB has a higher success rate,lower secondary lymph node imaging rate,and can be used as a single tracer in clinical practice.2.For breast cancer patients without axillary lymph node metastasis,after NAC treatment,99m Tc-Rituximab does not affect the detection efficiency of SLN.The postoperative local recurrence rate and distant metastasis rate are low,and the patient has a good prognosis.Part Ⅱ ObjectiveInternal mammary sentinel lymph node（IMLN）and axillary sentinel lymph node（ALN）were used as the first stage lymph node drainage site for breast cancer,which had important significance in staging,prognosis evaluation and treatment selection of breast cancer.However,due to the low detection rate of IMSLN,the application of IM-SLNB in breast cancer patients is still a controversial topic.The purpose of this study was to investigate the application of 99m Tc-rituximab in breast cancer（IMLNB）and the effect of different injection techniques on the detection rate of IM-SLN in breast cancer patients.Methods107 female breast cancer patients were selected.A total of 55 patients in Group A received 99mTc Rituximab injection 2-4h before surgery.Two injection sites were selected in the intradermal and surrounding glands on the surface of the mass,and two injection sites were selected in the intradermal and surrounding glands on the surface of the surgical incision for those who had received tumor resection.In group B,a total of 33 patients were injected 99mTc-rituximab into parenchymal glands 2-4h before surgery under the guidance of ultrasound.The injection sites were selected at 6 and 12 points in the periphery of the areola.19 patients in group C received 99m Tc-rituximab injection into the breast parenchymal glands 2-4h before surgery under the guidance of ultrasound.The injection sites were selected at 3o’clock,6 o’clock,9 o’clock and 12 o’clock in the peripheral areola area.99mTc-rituximab was labeled by our department,and 1m L was injected at each injection site,with a total radioactivity of about 17.5-29.6 MBq.All patients underwent tomography within 1-3 hours after injection,and the intraoperative"hot spots"were detected using a gamma detector,and the SLN was identified and removed for pathological examination.The detection rate of IMLN and ALN in different injection methods and injection sites were compared.Results1.The results showed that the detection rate of IM-SLN was 52.63%（10/19）in the 4-needle group,63.64%（21/33）in the 2-needle group,and 9.26%（5/54）in the peri-tumor subcutaneous injection group.The detection rate of the three injection methods was significantly different（χ2=30.602,P=0.000<0.05）,and the 2-injection and 4-injection groups were significantly better than the peri-tumor group.Further pair-based comparison showed that there was no significant difference in the detection rate between the 2-needle group and the 4-needle group（χ2=0.607,P=0.436）.The detection rates of 2-needle and 4-needle methods in the gland were both higher than those of the tumor peripheral method（χ2=16.195,P=0.000;χ2=28.904,P=0.000）.2.The average number of axillary SLNs detected by the three methods:132 SLNs were detected in the peritumor group,with an average of 2.40±1.29;In the second injection group,82 SLNs were detected in axilla（2.48±1.09 on average）.48 SLNs in axilla were detected in the 4-needle group,with an average of 2.53±1.31.There was no significant difference in the number of sentinel lymph nodes among the three methods.（χ2=0.224,P=0.885>0.05）.Conclusion1.After the ultrasound-guided large-volume intraglandular injection technology,the 99m Tc-Rituximab-guided IM-SLNB detection rate has been significantly improved,creating important conditions for minimally invasive treatment of internal breast lymph node biopsy and providing important conditions for accurate lymph node staging Technical support.2.When there are more than 2 injection sites,IM-SLNB by increasing the injection points does not improve the detection rate of IM-SLN,and even affects the intraoperative detection of IM-SLN to a certain extent. |
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