吲哚菁绿荧光导航联合亚甲蓝示踪在乳腺癌前哨淋巴结活检中的应用

Application of indocyanine green fluorescence navigation combined with methylene blue tracer in sentinel lymph node biopsy of breast cancer

目的评估吲哚菁绿(indocyaninegreen,ICG)荧光导航技术联合亚甲蓝染色法应用于早期乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的有效性及安全性。方法选取2017年5月至8月期间收治于大连医科大学附属第一医院的65例经空芯针穿刺活检确诊的浸润性乳腺癌患者,在行乳房全切或保乳手术前均以ICG及亚甲蓝作为示踪剂进行SLNB,分别统计荧光法、亚甲蓝染色法及亚甲蓝联合荧光法所检出的前哨淋巴结(sentinel lymph node,SLN)个数,并计算和比较3种方法SLN的检出率、准确率、灵敏度以及假阴性率有无差异。结果荧光法及亚甲蓝联合荧光法的前哨淋巴结平均检出个数均高于亚甲蓝染色法(P=0.010,P<0.001),并且使用亚甲蓝联合荧光法的前哨淋巴结检出率显著高于亚甲蓝染色法(100%vs.87.69%,P<0.001),但其假阴性率与亚甲蓝染色法相比并无统计学差异(15.38%vs.0,P=0.316)。结论ICG荧光示踪法联合亚甲蓝染色法行乳腺癌SLNB相对于亚甲蓝染色法有检出率高、SLNs平均检出个数多、淋巴管实时显像等优势,是安全、有效的SLNB的新方法。

Objective To evaluate the effectiveness and safety of fluorescent navigation technology with indocyanine green(ICG)combined with methylene blue staining in sentinel lymph node biopsy(SLNB)for early breast cancer patients.Methods Sixty-five patients with invasive breast cancer diagnosed by hollow core needle biopsy in the First Affiliated Hospital of Dalian Medical University from May to August 2017 were selected.ICG and methylene blue were used as tracers for SLNB before total mastectomy or breast conserving surgery.The sentinel lymph node(SLN)detected by fluorescence method,methylene blue staining method and methylene blue combined with fluorescence method were counted respectively.The detection rate,accuracy,sensitivity and false negative rate were calculated and compared.Results The average number of SLN detected by fluorescence method and methylene blue combined with fluorescence method was higher than that of methylene blue staining method(P=0.010,P<0.001).The detection rate by methylene blue combined with fluorescence method was significantly higher than that of methylene blue staining method(100%vs.87.69%,P<0.001).There was no significant difference in the false negative rate between methylene blue staining method and methylene blue staining method(15.38%vs.0,P=0.316).Conclusion Compared with methylene blue staining,ICG fluorescent tracer method combined with methylene blue staining for SLNB of breast cancer has the advantages of higher detection rate,higher average number of SLNs detected,and real-time imaging of lymphatic vessels,and thus is a safe and effective new method for SLNB.