SPECT/CT与三维造影成像构建乳腺癌内乳区淋巴引流模型研究

As a first-echelon nodal drainage site in breast cancer, the status of the internal mammary lymph nodes and axillary lymph nodes is valueable both for staging and treatment choice. However, there still lack an effective and feasible minimally invasive technique for the diagnosis of the internal mammary lymph nodes, leading to the inaccurate staging and over/under-treatment. The “new injection technique” breaked through the bottle-neck of the low internal mammary visulization rate with traditional injection technique (13%→71%),and make the internal mammary sentinel lymph node biopsy possible to be a minimally invasive assessment for the internal mammary lymph nodes status; however, because of the internal mammary lymphatic drainage pattern is unclear and breast cancer extended radical resection was abandoned, we can’t verify the accuracy of “new injection technique” directly, limiting its clinical application. This project by using the forward (injection of radionuclide tracer, using SPECT/CT image fusion technology, physiological analysis of internal mammary lymph drainage pattern) and reverse (injection of radiopaque contrast medium, using X-ray imaging and 3D reconstruction, rendering internal mammary lymph drainage anatomy atlas) two-way tracing technique, explore internal mammary lymphatic drainage pattern in breast cancer, and further constructs the lymphatic drainage model. The aim is to verify the hypothesis that the internal mammary sentinel lymph node biopsy guided by the new injection technology could accurately assess the internal mammary metastases status in breast cancer, and further offer more individual diagnositic and therapy for patients with breast cancer.

内乳区淋巴结和腋窝淋巴结同是乳腺癌转移“第一站”淋巴结，其转移状况是确定分期和治疗方案的重要依据，但一直缺乏内乳区淋巴结的微创诊断技术，常导致乳腺癌分期不准确、治疗不足/过度。课题组前期研发的“新型注射技术”突破了传统注射技术内乳区显像率极低的瓶颈（13%→71%），可望实现内乳区前哨淋巴结活检术对内乳区淋巴结的微创诊断；但由于内乳区淋巴引流规律不明和扩大根治术弃用，导致无法直接验证其准确性，限制了该技术的临床应用。本项目运用正向（注射核素示踪剂，利用SPECT/CT图像融合技术，分析内乳区淋巴引流的生理规律）与逆向（注射不透X线造影剂，利用X线显像和三维重建，绘制内乳区淋巴引流的解剖图谱）结合的双向示踪技术，探索乳腺癌内乳区淋巴引流规律，并进一步构建淋巴引流模型。目的是验证“新型注射技术引导的内乳区前哨淋巴结活检术可以准确评估乳腺癌内乳区转移状况”假说，使乳腺癌患者获得个体化的诊疗策略。

内乳区淋巴结和腋窝淋巴结同是乳腺癌转移“第一站”淋巴结，其转移状况是确定分期和治疗方案的重要依据，但一直缺乏内乳淋巴结的微创诊断技术，常导致乳腺癌分期不准确、治疗不足/过度。课题组前期研发的“新型注射技术”突破了传统注射技术内乳区显像率极低的瓶颈（13%→71%），可望实现内乳区前哨淋巴结活检术对内乳区淋巴结的微创诊断；但由于内乳区淋巴引流规律不明和扩大根治术弃用，导致无法直接验证其准确性，限制了该技术的临床应用。.本项目基于SPECT/CT图像融合技术和D2-40单克隆抗体淋巴管染色技术，从生理学和病理解剖学两个方面探索乳腺癌内乳区淋巴引流规律，构建乳腺癌内乳区淋巴引流模式，进而验证内乳区前哨淋巴结活检术的准确性和“新型注射技术”的代表性。.研究发现：1）乳腺癌内乳区淋巴引流规律是乳腺不同区域的淋巴引流至相同的内乳区淋巴结，并由此淋巴结向内乳区其他各级淋巴结引流；证明了内乳区引流模式同腋窝一样存在前哨淋巴结，同时内乳区前哨淋巴结不仅仅是引流乳腺原发肿瘤区域，也是引流整个乳腺的前哨淋巴结。2）新型注射技术引导内乳区前哨淋巴结活检术可以准确评估乳腺癌内乳区淋巴结转移状况，内乳区前哨淋巴结显像率为70.3%，转移率分别为8.8%（临床腋窝淋巴结阴性组）和38.3%（临床腋窝淋巴结阳性组），该微创诊断技术可以指导乳腺癌患者制定个体化内乳区放疗策略。.课题组发表项目相关论文21篇（包括13篇第一标注论文），参编英文著作1部。多次在国内外重要学术会议进行学术交流。研究成果获山东省优秀学位论文奖1项，山东省医科院科学技术一等奖 1 项。项目成果已应用于近 500 例乳腺癌患者的临床实践，其对乳腺癌患者的淋巴分期、转移途径认识和个体化精准治疗等多方面工作有重要的指导意义。

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