亚甲蓝及吲哚菁绿两种示踪剂在早期子宫恶性肿瘤中的应用比较

Methylene Blue versus Indocyanine Green tracer in the detection of sentinel lymph node in early-stage uterine malignancy

目的评估亚甲蓝及吲哚菁绿(ICG)在子宫恶性肿瘤(宫颈癌和子宫内膜癌)前哨淋巴结(SLN)的应用价值,探索两种不同示踪剂的示踪效果,为临床工作提供更多的示踪剂选择。方法选取2018年7月~2021年7月郑州大学第三附属医院妇科收治并经病理证实为子宫恶性肿瘤患者62例,包括宫颈癌30例和子宫内膜癌32例。所有病例术中均宫颈注射亚甲蓝或吲哚菁绿,在腹腔镜下进行前哨淋巴结(SLN)示踪,对两种示踪剂的显影情况和SLN的示踪效果进行分析。结果ICG组:33例患者中检出SLN的数量为31例,共检出160枚SLN,总检出率为93.9%,灵敏度为75%,特异度为100%,阳性预测值为100%,阴性预测值为96.2%;亚甲蓝组:29例患者中检出SLN的数量为25例,共检出114枚SLN总检出率为86.2%,灵敏度为66.7%,特异度为95.5%,阳性预测值为66.7%,阴性预测值为95.5%。ICG与亚甲蓝相比,具有较高的总检出率及灵敏度,但差异无统计学意义(P>0.05)。结论早期子宫恶性肿瘤应用ICG或亚甲蓝示踪剂,腹腔镜下显影的SLN均具有较高的检出率与准确率,是一种较为可行的方法,可根据实际情况进行选择。

Objective To evaluate the application value of methylene blue and indocyanine green(ICG) for sentinel lymph nodes(SLN) of uterine malignancies(cervical cancer and endometrial cancer), to explore the tracing effect of two different tracers, and to provide more tracer options in clinical work.Methods 62 cases(30 with cervical cancer and 32 with endometrial cancer) were conducted in the Third Affiliated Hospital of Zhengzhou University from July 2018 to July 2021. All cases were injected with methylene blue or indocyanine green into the cervix during operation, and sentinel lymph node(SLN) tracing was performed under laparoscopy, finally the visualization of the two tracers and the tracing effect of SLN were analyzed. Results In the ICG group, a total of 160 SLNs were detected, with an overall detection rate of 93.9%(31/33), sensitivity of 75%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96.2%;in the methylene blue group, 114 SLNs were detected. The total detection rate was 86.2%(25/29), sensitivity was 66.7%, specificity was 95.5%, positive predictive value was 66.7%, and negative predictive value was 95.5%. ICG had a higher total detection rate and sensitivity compared with methylene blue, but the difference was not statistically significant(P > 0.05). Conclusion The application of ICG or methylene blue tracer for early-stage uterine malignancies both have high detection rate and accuracy, which are more feasible methods and can be selected according to the actual situation.