吲哚菁绿联合亚甲蓝示踪法在乳腺癌前哨淋巴结活检术中的应用
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摘要
目的研究吲哚菁绿(indocyanine green,ICG)联合亚甲蓝的示踪方法在乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy, SLNB)中的应用价值。方法回顾性分析我院206例触诊腋窝淋巴结阴性,分别采用了亚甲蓝(亚甲蓝组,101例)或ICG联合亚甲蓝(联合组,105例)为示踪剂行前哨淋巴结活检术的早期乳腺癌患者的临床资料。结果联合组与亚甲蓝组前哨淋巴结(sentinel lymph nodes,SLNs)检出率分别为98%(103/105)、93%(94/101),两组比较差异无统计学意义(P>0.05)。联合组检出前哨淋巴结平均数为3.95枚/例;亚甲蓝组检出淋巴结平均数为2.23枚/例,两组前哨淋巴结数比较差异有统计学意义(P<0.05)。联合组检查前哨淋巴结数多为3枚以上,而亚甲蓝组检出的前哨淋巴结数目多为1～2枚(P<0.05)。两组之间前哨淋巴结阳性率无统计学意义。联合组阳性前哨淋巴结数多大于3枚,而亚甲蓝组阳性前哨淋巴结数目多为1～2枚。联合组较亚甲蓝组前哨淋巴结活检阳性出现非前哨淋巴结转移的比例更高(P<0.05)。结论 ICG联合亚甲蓝的示踪方法在乳腺癌前哨淋巴结活检中具有高效、直观和简便的优点及较高的临床实际应用价值。
Objective To evaluate the efficacy of indocyanine green(ICG) combined with methylene blue for the fluorescence-guided detection of sentinel lymph nodes(SLNs) during sentinel lymph node biopsy(SLNB) in patients with early breast cancer.Methods This retrospective study included a total of 206 female patients with early breast cancer.Patients were divided into methylene blue group and ICG plus methylene blue group.All SLNs that were collected during surgery were submitted for pathological examination.Axillary lymph nodes metastasis rates were observed postoperatively.Results The methylene blue detection rate of SLNs was 94%,with a mean of 2.23 SLNs per patient.The ICG plus methylene blue staining rate was 98%(P>0.05),with a mean of 2.93 SLNs per patient(P<0.05).44.6% patients in methylene blue group with SLNs metastasis,42.9% in methylene blue plus ICG group.The number of positive SLNs in ICG plus methylene blue group was higher than methylene blue group(P<0.05).There are more auxiliary lymph nodes metastasis cases in ICG plus methylene blue group(P<0.05).Conclusion Fluorescence-guided SLNB has several advantages and it is a valid method for clinical application.
Objective To evaluate the efficacy of indocyanine green(ICG) combined with methylene blue for the fluorescence-guided detection of sentinel lymph nodes(SLNs) during sentinel lymph node biopsy(SLNB) in patients with early breast cancer.Methods This retrospective study included a total of 206 female patients with early breast cancer.Patients were divided into methylene blue group and ICG plus methylene blue group.All SLNs that were collected during surgery were submitted for pathological examination.Axillary lymph nodes metastasis rates were observed postoperatively.Results The methylene blue detection rate of SLNs was 94%,with a mean of 2.23 SLNs per patient.The ICG plus methylene blue staining rate was 98%(P>0.05),with a mean of 2.93 SLNs per patient(P<0.05).44.6% patients in methylene blue group with SLNs metastasis,42.9% in methylene blue plus ICG group.The number of positive SLNs in ICG plus methylene blue group was higher than methylene blue group(P<0.05).There are more auxiliary lymph nodes metastasis cases in ICG plus methylene blue group(P<0.05).Conclusion Fluorescence-guided SLNB has several advantages and it is a valid method for clinical application.
引文
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[10]Van Driel P B,Van de Giessen M,Boonstra M C,et al.Characterization and evaluation of the artemis camera for fluorescence-guided cancer surgery[J].Mol Imaging Biol,2014,17(3):413-423.
[11]Liu J,Huang L P,Wang N,et al.Indocyanine green detects sentinel lymph nodes in early breast cance[J].J Int Med Res,2017,45(2): 514-524.
[2] 刘世斌,程晓明,曾峰,等.乳腺癌患者290例临床分析[J].遵义医学院学报,2013,36(5): 466-468.
[3] Goldhirsch A,Ingle J N,Gelber R D,et al.Thresholds for therapies:Highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer[J].Ann Oncol,2009,20( 8):1319-1329.
[4] Stoffels I,Dissemond J,Pppel T,et al. Intraoperative fluorescence imaging for sentinel lymph node detection: prospective clinical trial to compare the usefulness of indocyanine green vs technetium Tc 99m for identification of sentinel lymph nodes[J].JAMA Surg,2015,150(7): 617-623.
[5] 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.
[6] Eriksson A G,Beavis A,Soslow R A,et al.A comparison of the detection of sentinel lymph nodes using indocyanine green and near-infrared fluorescence imaging versus blue dye during robotic surgery in uterine cancer[J].Int J Gynecol Cancer,2017,27(4):743-747.
[7] Takemoto N,Koyanagi A,Yasuda M,et al.Comparison of the indocyanine green dye method versus the combined method of indigo carmine blue dye with indocyanine green fluorescence imaging for sentinel lymph node biopsy in breast conservative therapy for stage ≤IIA breast cancer[J].BMC Womens Health,2018,18(1):151.
[8] Maimaitiaili A,Wu D,Liu Z,et al.Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients[J].Cancer Biol Med,2018,15(3):282-289.
[9] Shimazu K,Sato N,Ogiya A,et al.Intraoperative nomograms,based on one-step nucleic acid amplification,for prediction of non-sentinel node metastasis and four or more axillary node metastases in breast cancer patients with sentinel node metastasis[J].Ann Surg Oncol,2018,25(9):2603-2611.
[10]Van Driel P B,Van de Giessen M,Boonstra M C,et al.Characterization and evaluation of the artemis camera for fluorescence-guided cancer surgery[J].Mol Imaging Biol,2014,17(3):413-423.
[11]Liu J,Huang L P,Wang N,et al.Indocyanine green detects sentinel lymph nodes in early breast cance[J].J Int Med Res,2017,45(2): 514-524.