乳腺癌前哨淋巴结活检方法中国研究现状
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摘要
前哨淋巴结(SLN)转移情况的评估,对乳腺癌病人腋窝淋巴结处理有重要意义。染料法联合核素法是应用于乳腺癌前哨淋巴结活检(SLNB)检出率最高的方法,且仍处于主导地位,但由于其存在的一些无法克服的问题,因而不断有新的SLNB方法应用于临床,如超声造影、近红外荧光染料法(吲哚菁绿,ICG)、纳米碳和超顺磁性氧化铁(SPIO)等。这些新方法、新技术使SLNB多样化,无核素污染,更加微创,并且检出率、敏感性、特异性也与传统方法媲美。特别是使用超声造影(定位)引导下细针穿刺细胞病理学检查(定性)的术前评估SLN情况的超微创新方法,可将传统的术中SLN评估提前至术前,使乳腺癌的临床实践更具合理性。此外,乳腺癌内乳淋巴结的评估,也有助于临床分期更全面,对内乳淋巴结检测的新观点及检测技术的改进,本文也进行了综述。
The evaluation of sentinel lymph node metastasis has important guiding significance for the treatment of axillary lymph nodes in breast cancer patients.At present,although the dual isotope with blue dye method,which also has dominant position in breast cancer treatment,is the highest detection method for sentinel lymph node biopsy(SLNB),due to some insurmountable problems,there are new SLNB methods for clinical application,such as contrast enhanced ultrasound,near-infrared fluorescent method(indocyanine green ICG),carbon nanoparticle suspension,superparamagnetic iron oxide(SPIO)and so on.These new methods and technologies make SLNB diversified,nucleus-free,and less invasive,and the detection rate,sensitivity,and specificity are comparable to traditional methods.In particular,the ultra-innovative method of preoperative evaluation of SLN using fine-needle aspiration cytology(qualitative)guided by contrast-enhanced ultrasound(positioning)can advance the traditional intraoperative SLN assessment to preoperative,so that the clinical stage of breast cancer Practice is more rational.In addition,the evaluation of Internal mammary lymph node in breast cancer also contributes to a more comprehensive clinical stage.This article also reviews the new perspectives on the detection of internal mammary lymph nodes and the improvement of detection techniques.
The evaluation of sentinel lymph node metastasis has important guiding significance for the treatment of axillary lymph nodes in breast cancer patients.At present,although the dual isotope with blue dye method,which also has dominant position in breast cancer treatment,is the highest detection method for sentinel lymph node biopsy(SLNB),due to some insurmountable problems,there are new SLNB methods for clinical application,such as contrast enhanced ultrasound,near-infrared fluorescent method(indocyanine green ICG),carbon nanoparticle suspension,superparamagnetic iron oxide(SPIO)and so on.These new methods and technologies make SLNB diversified,nucleus-free,and less invasive,and the detection rate,sensitivity,and specificity are comparable to traditional methods.In particular,the ultra-innovative method of preoperative evaluation of SLN using fine-needle aspiration cytology(qualitative)guided by contrast-enhanced ultrasound(positioning)can advance the traditional intraoperative SLN assessment to preoperative,so that the clinical stage of breast cancer Practice is more rational.In addition,the evaluation of Internal mammary lymph node in breast cancer also contributes to a more comprehensive clinical stage.This article also reviews the new perspectives on the detection of internal mammary lymph nodes and the improvement of detection techniques.
引文
[1] Bouquet J,Major A,Khomsi F,et al.The sentinel lymph node in breast cancer:problems posed by examination during surgery.a review of current literature and management[J].Front Surg,2018,14(5):56.
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[13] Liu J,Huang L,Wang N,et al.Indocyanine green detects sentinel lymph nodes in early breast cancer[J].J Int Med Res,2017,45(2):514-524.
[14] Zhang X,Li Y,Zhou Y,et al.Diagnostic Performance of Indocyanine Green-Guided Sentinel Lymph Node Biopsy in Breast Cancer:A Meta-Analysis[J].PLoS One,2016,11(6):e0155597.
[15] 侯丁丁,康骅.近红外荧光在乳腺癌前哨淋巴结活检中的应用现状[J].临床外科杂志,2016,24(9):719-721.
[16] 雷双根,余小芬,谢春伟,等.吲哚菁绿联合亚甲蓝染色在老年乳腺癌前哨淋巴结活检中的应用[J].江西医药,2018,53(10):59-61,73.
[17] 李盼盼,王永胜.乳腺癌前哨淋巴结活检术新型示踪剂的研究进展[J].中国癌症杂志,2016,26(12):1031-1036.
[18] Madsen EV,Aalders KC,van der Heiden-van der Loo M,et al.Prognostic significance of tumor-positive internal mammary sentinel lymph nodes in breast cancer:a multicenter cohort study[J].Ann Surg Oncol,2015,22(13):4254-4262.
[19] Van der Ent FW,Kengen RA,Van der Pol HA,et al.Halsted revisited:internal mammarysentinel lymph node biopsy in breast cancer[J].Ann Surg,2001,234(1):79-84.
[20] Estourgie SH,Tanis PJ,Nieweg OE,et al.Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients[J].Ann Surg Oncol,2003,10(8):935-941.
[21] Bourre JC,Payan R,Collomb D,et al.Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation[J].Eur J Nucl Med Mol Imaging,2009,36(5):758-764.
[22] Postma EL,van Wieringen S,Hobbelink MG,et al.Sentinel lymph node biopsy of the internal mammary chain in breast cancer[J].Breast Cancer Res Treat,2012,252(3):426-432.
[23] Postma EL,van Wieringen S,Hobbelink MG,et al.Sentinel lymph node biopsy of the internal mammary chain in breast cancer[J].Breast Cancer Res Treat,2012,134(2):735-741.
[24] Caudle AS,Yi M,Hoffman KE,et al.Impact of identification of internal mammary sentinel lymph node metastasis in breast cancer patients[J].Ann Surg Oncol,2014,21(1):60-65.
[25] 周梦,金梅,王琳,等.乳腺癌内乳区前哨淋巴结临床研究[J].中国现代医学杂志,2018,28(3):92-96.
[26] Qiu PF,Cong BB,Zhao RR,et al.Internal Mammary Sentinel Lymph Node Biopsy With Modified Injection Technique:High Visualization Rate and Accurate Staging[J].Medicine(Baltimore),2015,94(41):e1790.
[27] 孙晓,丛斌斌,邱鹏飞,等.临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究[J].中国肿瘤临床,2015,42(6):341-344.
[28] 杨世昕,瞿伟,涂剑宏,等.246例临床早期乳腺癌采用纳米碳示踪剂进行前哨淋巴结活检结果分析与思考[C]// 2015年第七届江西乳腺疾病高层论坛会议资料汇编.2015.
[29] 王敏,姚峰.应用纳米炭混悬液行乳腺癌前哨淋巴结活检的临床研究[J].中华实用诊断与治疗杂志,2018,32(4):358-361.
[2] Bevers TB,Helvie M,Bonaccio E,et al.Breast Cancer Screening and Diagnosis,Version 3.2018,NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw, 2018,16(11):1362-1389.
[3] Xie F,Zhang D,Cheng L,et al.Intradermal microbubbles and contrast-enhanced ultrasound(CEUS)is a feasible approach for sentinel lymph node identification in early-stage breast cancer[J].World J Surg Oncol,2015,13:319.
[4] 于志强,李志旺,韦伟,等.超声造影指导乳腺癌前哨淋巴结活检的价值[J].中国老年学杂志,2013,33(3):533-535.
[5] Zhong J,Sun D,Wei W,et al.Contrast-Enhanced Ultrasound-Guided Fine-Needle Aspiration for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer[J].Ultrasound Med Biol,2018,44(7):1371-1378.
[6] Shimazu K,Ito T,Uji K,et al.Identification of sentinel lymph nodes by contrast-enhanced ultrasonography with Sonazoid in patients with breast cancer:a feasibility study in three hospitals[J].Cancer Med,2017,6(8):1915-1922.
[7] Sever A,Mills P,Weeks J,et al.Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer[J].AJR Am J Roentgenol,2012,199(2):465-470.
[8] Rautiainen S,Sudah M,Joukainen S,et al.Contrast-enhanced ultrasound -guided axillary lymph node core biopsy:Diagnostic accuracy in preoperative staging of invasive breast cancer[J].Eur J Radiol,2015,84(11):2130-2136.
[9] Nielsen A,Bull J,Culpan A,Preoperative sentinel lymph node identification,biopsy and localisation using contrast enhanced ultrasound(CEUS)in patients with breast cancer:a systematic review and meta-analysis[J].Clin Radiol,2017,72(11):959-971.
[10] Kitai T,Inomoto T,Miwa M,et al.Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer[J].Breast Cancer,2005,12(3):211-215.
[11] 王殊,杨德起,佟富中,等.自发荧光物质吲哚菁绿在乳腺癌前哨淋巴结活检的应用.中华医学会肿瘤学分会第七届全国中青年肿瘤学术会议——中华医学会肿瘤学分会“中华肿瘤明日之星”大型评选活动暨中青年委员全国遴选论文汇编[C].2011.
[12] Guo J,Yang H,Wang S,et al.Comparison of sentinel lymph node biopsy guided by indocyanine green,blue dye,and their combination in breast cancer patients:a prospective cohort study[J].World J Surg Oncol,2017,15(1):196.
[13] Liu J,Huang L,Wang N,et al.Indocyanine green detects sentinel lymph nodes in early breast cancer[J].J Int Med Res,2017,45(2):514-524.
[14] Zhang X,Li Y,Zhou Y,et al.Diagnostic Performance of Indocyanine Green-Guided Sentinel Lymph Node Biopsy in Breast Cancer:A Meta-Analysis[J].PLoS One,2016,11(6):e0155597.
[15] 侯丁丁,康骅.近红外荧光在乳腺癌前哨淋巴结活检中的应用现状[J].临床外科杂志,2016,24(9):719-721.
[16] 雷双根,余小芬,谢春伟,等.吲哚菁绿联合亚甲蓝染色在老年乳腺癌前哨淋巴结活检中的应用[J].江西医药,2018,53(10):59-61,73.
[17] 李盼盼,王永胜.乳腺癌前哨淋巴结活检术新型示踪剂的研究进展[J].中国癌症杂志,2016,26(12):1031-1036.
[18] Madsen EV,Aalders KC,van der Heiden-van der Loo M,et al.Prognostic significance of tumor-positive internal mammary sentinel lymph nodes in breast cancer:a multicenter cohort study[J].Ann Surg Oncol,2015,22(13):4254-4262.
[19] Van der Ent FW,Kengen RA,Van der Pol HA,et al.Halsted revisited:internal mammarysentinel lymph node biopsy in breast cancer[J].Ann Surg,2001,234(1):79-84.
[20] Estourgie SH,Tanis PJ,Nieweg OE,et al.Should the hunt for internal mammary chain sentinel nodes begin? An evaluation of 150 breast cancer patients[J].Ann Surg Oncol,2003,10(8):935-941.
[21] Bourre JC,Payan R,Collomb D,et al.Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation[J].Eur J Nucl Med Mol Imaging,2009,36(5):758-764.
[22] Postma EL,van Wieringen S,Hobbelink MG,et al.Sentinel lymph node biopsy of the internal mammary chain in breast cancer[J].Breast Cancer Res Treat,2012,252(3):426-432.
[23] Postma EL,van Wieringen S,Hobbelink MG,et al.Sentinel lymph node biopsy of the internal mammary chain in breast cancer[J].Breast Cancer Res Treat,2012,134(2):735-741.
[24] Caudle AS,Yi M,Hoffman KE,et al.Impact of identification of internal mammary sentinel lymph node metastasis in breast cancer patients[J].Ann Surg Oncol,2014,21(1):60-65.
[25] 周梦,金梅,王琳,等.乳腺癌内乳区前哨淋巴结临床研究[J].中国现代医学杂志,2018,28(3):92-96.
[26] Qiu PF,Cong BB,Zhao RR,et al.Internal Mammary Sentinel Lymph Node Biopsy With Modified Injection Technique:High Visualization Rate and Accurate Staging[J].Medicine(Baltimore),2015,94(41):e1790.
[27] 孙晓,丛斌斌,邱鹏飞,等.临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究[J].中国肿瘤临床,2015,42(6):341-344.
[28] 杨世昕,瞿伟,涂剑宏,等.246例临床早期乳腺癌采用纳米碳示踪剂进行前哨淋巴结活检结果分析与思考[C]// 2015年第七届江西乳腺疾病高层论坛会议资料汇编.2015.
[29] 王敏,姚峰.应用纳米炭混悬液行乳腺癌前哨淋巴结活检的临床研究[J].中华实用诊断与治疗杂志,2018,32(4):358-361.