吲哚菁绿-纳米碳联合示踪在乳腺癌前哨淋巴结活检中的应用

Combination of indocyanine green and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients

目的：探讨吲哚菁绿联合纳米碳作为淋巴示踪剂在乳腺癌前哨淋巴结活检手术中的应用价值。方法将112例临床腋窝淋巴结阴性的乳腺癌患者随机分为2组，56例接受吲哚菁绿联合纳米碳示踪，56例接受单药吲哚菁绿示踪。2组均进行前哨淋巴结活检手术，手术切除的前哨淋巴结送术中冰冻及常规石蜡和免疫组织化学病理检查。结果联合示踪组体外淋巴管显影率为94.6％（53／56），单药示踪组体外淋巴管显影率为96.4％（54／56）。联合组54例可见明显荧光浓聚，52例可见明显黑染淋巴结，2例无明显荧光浓聚患者可找到黑染淋巴结，4例未见黑染淋巴结可荧光显影，均成功检出前哨淋巴结，检出率100％（56／56）；单药示踪组检出率92.9％（52／56）（χ2＝2.3，P＞0.050）。联合示踪组共检出前哨淋巴结205枚，平均（3.7±1.5）枚；单药示踪组共检出前哨淋巴结130枚，平均（2.5±1.4）枚（t＝－3.5，P＝0.001）。联合示踪组10例淋巴结阳性，共检出阳性淋巴结17枚；单药示踪组9例淋巴结阳性共检出阳性淋巴结12枚。结论联合应用吲哚菁绿和纳米碳进行乳腺癌前哨淋巴结活检，可实现优势互补以增加前哨淋巴结检出率和检出数，降低漏诊率和假阴性率。

Objective To evaluate intraoperative tracing of sentinel lymph nodes （ SLNs） by fluorescence imaging combined with carbon nanoparticles .Methods 112 breast cancer patients eligible for sentinel lymph node biopsy were randomly assigned to the combination group （56 cases）receiving indocyanine green （ICG）and carbon nanoparticles as the lymphatic mapping tracers and ICG alone group （56 cases）.Intraoperative frozen sec-tion was performed , followed by conventional histopathology .Results In the combination group , subcutaneous lymphatic vessels were successfully visualized in 53 patients and the detection rate was 94.6%（53/56）.The flu-orescence SLNs were successfully detected in 54 patients and the detection rate was 96.4%（54/56）in ICG alone group.In the combination group , SLNs were successfully identified in 54 patients by fluorescence and 52 patients by black dyed, and the SLNs detection rate was 100%（56/56）.While in the ICG alone group, the SLNs were found in 52 patients and the detection rate was 92.9%（52/56）（χ2 =2.3, P〉0.050）.The average number of detected SLNs was 3.7 ±1.5 （ 205/56 ） in combination group vs 2.5 ±1.4 （ 130/52 ） in ICG alone group （ t =-3.5, P=0.001）.17 metastatic SLNs were found in 10 patients in the combination group vs 12 metastatic SLNs in 9 patients in ICG alone group .Conclusion Combination of ICG and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients can increase the number of SLNs detected and the detection rate , reducing the rate of misdiagnosis and false negative rate .