单独或联合使用不同示踪剂在乳腺癌前哨淋巴结活检术中应用的对比研究  

A comparative study of single or combined use of different tracers in sentinel lymph node biopsy of breast cancer

作　　者：张爱玲[1] 宾莲洁 何广宁[1] 叶建森 林伟强[1] 黄河清[1] 叶娴 王在国[2] 

机构地区：[1]广东省东莞市人民医院乳腺科,广东东莞523000 [2]广东省东莞市人民医院肿瘤外科,广东东莞523000

出　　处：《临床和实验医学杂志》2018年第13期1431-1435,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省东莞市科技局支持项目(编号:201505101208)

摘　　要：目的对比分析单独或联合使用不同示踪剂在定位乳腺癌前哨淋巴结活检术中的应用价值。方法前瞻性选取2015年10月至2017年10月广东省东莞市人民医院收治的400例活检确诊的浸润性乳腺癌患者,所有患者均在保乳术或改良根治术前接受前哨淋巴结示踪活检。按照随机数字表法将患者分为3组:蓝染组(n=132)、荧光组(n=132)和新型组(即荧光+蓝染联合组)(n=136)。蓝染组示踪剂是亚甲蓝;荧光组示踪剂是吲哚氰绿;新型组采用荧光(ICG)联合蓝染双示踪。几种方法均行手术将前哨淋巴结分离出来,单独送病理检查。对比3组中每例乳腺癌患者前哨淋巴结(SLN)检出数量以及检出率、假阴性、准确率。结果新型组每个患者检出的SLN平均数量较蓝染组、荧光组多,差异均有统计学意义(P<0.05);新型组SLN检出率(97.79%)、准确率(98.49%)较单独蓝染组(86.36%、72.81%)和单荧光组(91.67%、84.30%)高;而假阴性率(0.00%)较蓝染组(16.90%)和荧光组(2.33%)低,差异具有统计学意义(P<0.05)。荧光组较蓝染组检出率、准确率高,假阴性率低,差异具有统计学意义(P<0.05)。结论新型组即荧光+蓝染联合组检出率和准确率均较蓝染组和荧光组高,且明显降低了假阴性率。新型联合双示踪法更适合用于乳腺癌术中前哨淋巴结活检及对腋窝淋巴结的综合评估,从而对保腋窝有更理想的指导意义。荧光组检出率和准确率均较蓝染组高,且实时可见,更敏感,技术上更容易掌握,也是一种较好的前哨淋巴结活检术的单示踪方法 。Objective To compare the value of single or combined use of different tracers in the localization of sentinel lymph node biopsy in breast cancer. Methods A prospective selection of 400 biopsy-proven invasive breast cancer patients from October 2015 to October 2017 in Dongguan City,Guangdong Province were performed. All patients received sentinel lymph node biopsy before breast-conserving surgery or modified radical mastectomy. Patients were divided into three groups according to the random number table method： blue staining group（ n = 132）,fluorescence group（ n = 132）,and novel group（ ie,fluorescence ＋ blue staining combined group）（ n = 136）. The tracer in the blue dye group was methylene blue; the fluorescent group tracer was indocyanine green; the new group was fluorescent（ ICG） combined with blue dye double tracer. In several methods,sentinel lymph nodes were surgically removed and sent for pathological examination. The number of sentinel lymph nodes（ SLN） and the detection rate,false negatives,and accuracy of each breast cancer patient in the three groups were compared. Results The average number of SLN detected in each patient in the novel group was more than that in the blue staining group and the fluorescence group（ P〈0. 05）. The detection rate of the new type of SLN（ 97. 79%） and the accuracy rate（ 98. 49%） were significantly higher compared with the blue staining group（ 86. 36%,72. 81%） and the single fluorescence group（ 91. 67%,84. 30%）,the false negative rate（ 0. 00%） was lower than those in the blue staining group（ 16. 90%） and the fluorescence group（ 2. 33%）. The difference was statistically significant（ P〈0. 05）. The detection rate and accuracy of the fluorescent group were higher than those of the blue group,and the false negative rate was lower. The difference was statistically significant（ P〈0. 05）. Conclusion The detection rate and accuracy of the new group,the fluorescence ＋ blue staining group,were higher than those in

关 键 词：乳腺癌 前哨淋巴结活检 检出率 准确率 假阴性率 蓝染 荧光 

分 类 号：R737.9[医药卫生—肿瘤]