在乳腺癌前哨淋巴结活检中应用亚甲蓝单示踪剂和亚甲蓝联合核素双示踪剂的效果比较

Comparative study ofmethylene blue tracer and double tracer containing nuclide in sentinel lymph node biopsy of breast cancer

目的比较在乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)中使用亚甲蓝单示踪剂和亚甲蓝联合核素双示踪剂的效果。方法2017年11月至2019年10月,就诊于山东省肿瘤医院的乳腺癌患者92例,SLNB均使用亚甲兰联合核素双示踪剂;就诊于济宁市第一人民医院的患者92例,SLNB均使用亚甲兰单示踪剂。比较两组前哨淋巴结(SLN)的检出数量、检出率、准确率、灵敏度、假阴性率,分析患者的年龄、月经情况、肿瘤部位、肿瘤长径、临床分期、病理类型、雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER-2)、分子分型、动态增强磁共振成像(DCE-MRI)对SLN检出率的影响。结果单示踪剂组的检出数量、检出率、准确率、灵敏度、假阴性率分别为(3.20±1.10)枚、90.22%、93.48%、95.24%和4.76%,双示踪剂组分别为(3.37±1.02)枚、92.39%、95.65%、95.65%和4.35%,两组差异均无统计学意义(均P>0.05)。按照患者的年龄、月经情况、病理类型、临床分期、肿瘤部位、ER表达、PR表达、HER-2表达、分子分型分层后,单示踪剂组和双示踪剂组的SLN检出率差异均无统计学意义(均P>0.05)。但按照肿瘤长径和DCE-MRI检查分层后,在肿瘤长径为2~5 cm或未行DCE-MRI检查的情况下,单示踪剂组的SLN检出率明显低于双示踪剂组(均P<0.05)。结论在乳腺癌SLNB中使用亚甲蓝单示踪剂和亚甲蓝联合核素双示踪剂SLN活检的效果相当,可以在基层医院推广乳腺癌亚甲蓝单示踪剂SLNB。

Objective To compare the application effect of blue dye single tracer and blue dye combined with nuclide double tracer in sentinel lymph node biopsy(SLNB)of breast cancer surgery.Methods A total of 92 breast cancer patients in Shandong Cancer Hospital and Institute from November 2017 to October 2019 underwent methyleneblue dye combined with 99Tcm sulfur colloid nuclide double tracer in SLNB,while other 92 cases in Jining First People Hospital underwent blue dye single tracer.The number of SLN detection,detection rate,accuracy rate,sensitivity,and false negative rate of the two groups were compared.The impacts of age,menstruation,tumor location,tumor size,clinical stage,pathological type,and estrogen receptor(ER),progesterone receptor(PR),human epidermal receptor 2(HER-2),molecular typing,dynamic enhanced magnetic resonance imaging(DCE-MRI)on the detection rate of SLN were analyzed.Results The number of detection,detection rate,accuracy,sensitivity,and false negative rate of the blue dye single tracer group were 3.20±1.10,90.22%,93.48%,95.24%and 4.76%,respectively;the double tracer group were 3.37±1.02,92.39%,95.65%,95.65%and 4.35%,respectively,without significant difference(all P>0.05).In different age,menstrual condition,tumor location,clinical stage,pathological type,ER,PR,HER-2 expression and molecular typing,the detection rate of single tracer group and double tracer group had no significant difference(all P>0.05).However,in the tumor size of 2-5 cm and without DCE-MRI examination,the detection rate of single tracer group was significantly lower than that of double tracer group.Conclusion The effect of blue dye single tracer in detecting SLN of breast cancer is equivalent to that of double tracer method,which is worthy of promotion and application in primary hospitals.