吲哚菁绿联合美蓝在乳腺癌腋窝前哨淋巴结活检的临床应用价值

Clinical value of combining indocyanine green fluorescence navigation with blue dye in sentinel lymph node biopsy in patients with breast cancer

目的:探讨吲哚菁绿(indocyanine green,ICG)荧光导航法联合美蓝示踪法在乳腺癌腋窝前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中的临床应用价值。方法:收集2013年5月至2014年4月广东省汕头中心医院符合入组标准的89例早期乳腺癌患者。其中第一阶段,53例术中行ICG联合美蓝注射,并利用淋巴荧光显像及美蓝示踪行前哨淋巴结活检术联合腋窝淋巴结清扫术(axillary lymph node dissection ALND);第二阶段,36例术中前哨淋巴结(sentinel lymph node,SLN)冰冻病理阴性患者不再行腋窝淋巴结清扫。统计SLN的检出成功率、准确率及假阴性率。结果:89例患者的SLN检出成功率为96.6%(86/89),第一阶段检出成功率为94.3%(50/53)、准确率98.0%(49/50)、假阴性率2.6%(1/38),第二阶段检出成功率为100%(36/36)。ICG荧光导航法联合美蓝示踪法检出196枚SLN中荧光显示为179枚,196枚SLN其中显示蓝染142枚、未显示蓝染的54枚仅显示荧光。196枚SLN中有转移为45枚,5枚仅显示荧光。22例患者SLN转移,转移率为24.7%(22/89),2例患者的SLN仅显示荧光而未蓝染。中位随访时间为25个月,未发现同侧区域淋巴结复发。结论:ICG荧光导航法联合美蓝示踪法能够安全有效地应用于乳腺癌前哨淋巴结活检。

Objective： To examine the clinical value of combining indocyanine green （ICG） fluorescence navigation with blue dye in sentinel lymph node biopsy （SLNB） for patients with breast cancer. Methods： A total of 89 patients with earlystage breast cancer who met the inclusion criteria were admitted at Shantou Central Hospital, Guangdong from May 2013 to April 2014. In phase one, ICG and blue dye were applied in all 53 patients, and then SLNB and axillary lymph node dissection （ALND） were performed based on fluorescence signal or visual sense of the lymph nodes. In phase two, 36 patients with early-stage breast cancer were included. ALND was omitted when sentinel lymph nodes were frozen showing negative result. Rates of detection, accuracy, and false-negative were calculated. Results： A total of 89 patients were monitored, of which the total rate of SLNB detection was 96.6% （86/89）. In the validation period, the rates of detection, accuracy, and false-negative were 94.3% （50/53） 98.0% （49/50）, and 2.6% （1/38）, respectively. In the alterative period, the rates of detection reached 100%. Of the 196 sentinel lymph nodes, 179 showed fluorescence signal, 142 exhibited blue dying, 54 only demonstrated fluorescence signals, and 45 demonstrated metastasis with five signaling fluorescence. About 24.7% of patients were diagnosed with SLN metastasis （22/89）, where SLNB in two patients showed fluorescence signal but without blue dye. No ipsilateral lymph node relapsed were observed during a median follow up of 25 months. Conclusion： Combination of ICG fluorescence navigation with blue dye in SLNB is safe for patients with breast cancer.