吲哚菁绿联合亚甲蓝在乳腺癌前哨淋巴结活检中的应用

Application of Indocyanine Green combined with Methylene Blue in sentinel lymph node biopsy of breast cancer

目的:将吲哚菁绿(ICG)联合亚甲蓝应用于乳腺癌前哨淋巴结(SLN)活检(SLNB),比较双示踪剂显示的SLN与单示踪剂显示的SLN之间SLN检出率及转移阳性率,探讨该示踪方法的可行性。方法:选取140例术前病理诊断乳腺癌的患者,采用ICG与亚甲蓝联合示踪的方法,对患者进行术中SLNB。将检出的SLN分为4组:联合组,即有亚甲蓝显色或ICG荧光显影的SLN;亚甲蓝组,即有亚甲蓝显色的SLN;ICG组,即有荧光显色的SLN;无显示组:既没有亚甲蓝显色也没有ICG荧光显影的SLN。分析比较联合组、亚甲蓝组及ICG组之间的SLN检出率、转移阳性率。结果:联合组SLN检出率99.3%(139/140),高于亚甲蓝组92.9%(130/140)及ICG组95.0%(133/140),差异有统计学意义(P<0.05);ICG组SLN检出率高于亚甲蓝组,差异无统计学意义(P>0.05);联合组SLN转移阳性率(6.27%)高于亚甲蓝组(5.32%)及ICG组(6.08%),差异均无统计学意义(P>0.05);ICG组SLN转移阳性率高于亚甲蓝组,差异无统计学意义(P>0.05)。结论:ICG联合亚甲蓝应用于乳腺癌SLNB中,可以得到较高的SLN检出率,检出更多转移的SLN,有利于准确进行腋窝淋巴结分期。

Objective: To explore the feasibility of tracer method by compare the detection rate and metastasis positive rate of sentinel lymph node(SLN) between SLN displayed by double tracer and single tracer when Indocyanine Green(ICG) combined with Methylene Blue was applied to breast cancer SLN biopsy(SLNB). Methods: 140 patients who confirmed to have breast cancer by preoperative hollow needle puncture or mass resection biopsy were selected. Intraoperative SLNB was performed using ICG and Methylene Blue combined tracer method. The detected SLNs were divided into four groups: combined group, namely SLN with Methylene Blue color and/or ICG fluorescence, Methylene Blue group, namely SLN with Methylene Blue color, ICG group, namely SLN with fluorescent, no shown group, namely SLN with neither Methylene Blue nor ICG fluorescene. The SLN detection rate and the positive rate of metastasis among combined group, Methylene Blue group and ICG group were analyzed and compared. Results: The SLN detection rate of the combined group was higher(99.3%, 139/140)than that of the Methylene Blue group(92.9%, 130/140) and ICG group(95.0%, 133/140), which was statistically significant(P< 0.05). The SLN detection rate in ICG group was higher than that in Methylene Blue group, but there was no statistical significance(P>0.05). SLN metastasis positive rate in the combined group(6.27%) was higher than that in the Methylene Blue group(5.32%)and ICG group(6.08%), both of them was no statistical significance(P>0.05). The SLN metastasis positive rate in ICG group was higher than that in Methylene Blue group, also was no statistical significance(P>0.05). Conclusions: The application of ICG combined with Methylene Blue in breast cancer SLNB can obtain a higher SLN detection rate and detect more metastatic SLN, which is conducive to accurate staging of axillary lymph nodes.