乳腺癌前哨淋巴结活检中吲哚菁绿示踪剂的价值分析  

Analysis of the Value of Indocyanine Green Tracer in Sentinel Lymph Node Biopsy of Breast Tumor

作　　者：白海亚[1] 刘慧民[1] 杨萍[1] 龚晓军[1] 姚东刚[1] 卢俊阳[1] Bai Haiya;Liu Huimin;Yang Ping(Second Department of Breast Surgery,Maternal and Child Care Hospital of Gansu Province,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院乳腺二科

出　　处：《中国微创外科杂志》2020年第1期14-18,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：甘肃省自然科学基金(17JR5RA025)

摘　　要：目的探讨吲哚菁绿(indocyanine green,ICG)、亚甲蓝(methylene blue,MB)及两者联合在前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中的价值。方法将我院2014年1月~2017年7月临床腋窝淋巴结阴性的原发性乳腺癌171例随机分为ICG组、联合组、MB组,每组57例。均按常规行SLNB,然后行Ⅰ、Ⅱ水平腋窝淋巴清扫。结果159例成功检出SLN,共检出SLN 501枚,平均3.2枚/例。ICG组检出SLN 191枚,平均3.5枚/例;联合组检出SLN 186枚,平均3.3枚/例,SLN中荧光显影为184枚,同时蓝染131枚,仅显示荧光未显示蓝染53枚;MB组检出SLN 124枚,平均2.6枚/例。ICG组检出率96.5%(55/57),与联合组98.2%(56/57)比较无统计学差异(χ^2=0.000,P=1.000),MB组检出率84.2%(48/57),明显低于ICG组(χ^2=4.930,P=0.026)和联合组(χ^2=5.371,P=0.020)。SLN检出数目ICG组和联合组分别为(3.5±1.0)、(3.3±1.2)枚,明显多于MB组(2.6±1.4)枚(P值分别为0.000,0.001),但ICG组与联合组无统计学差异(P=0.484)。准确率ICG组98.2%(54/55)、联合组98.2%(55/56)、MB组93.8%(45/48),3组比较均无明显统计学差异(χ^2=2.177,P=0.337)。假阴性率ICG组3.8%(1/26)、联合组4.5%(1/22)、MB组14.3%(3/21),3组比较均无明显统计学差异(χ^2=2.234,P=0.327)。结论含有ICG示踪剂荧光定位,具有良好的可视性,定位准确、检出率高,优于单用MB法。单独使用ICG定位,即可达到理想的SLN检出率,不需要联合MB。Objective To evaluate the value of indocyanine green(ICG),methylene blue(MB)and their combination in sentinel lymph node biopsy(SLNB).Methods A total of of 171 patients with primary breast cancer who were admitted to our hospital with negative clinical axillary lymph nodes from January 2014 to July 2017 was analyzed.They were randomly divided into ICG group,combined group and MB group,with 57 cases in each group.The SLNB was routinely performed,withⅠandⅡlevels of axillary lymphatic dissection.Results Of the 171 patients,159 were successfully detected in sentinel lymph nodes,and a total of 501 sentinel lymph nodes were detected,with an average of 3.2 per patient.The ICG group had 191 sentinel lymph nodes,with an average of 3.5 nodes per patient.The combined group had 186 sentinel lymph nodes,with an average of 3.3 nodes per patient.The fluorescence staining in the sentinel lymph nodes was found 184 nodes,including 131 nodes with blue staining and 53 nodes with only fluorescence staining.The total number of sentinel lymph nodes detected in MB group was 124,with an average of 2.6 nodes per patient.In terms of the detection rate of sentinel lymph nodes,there was no statistical difference(χ^2=0.000,P=1.000)between the ICG group(96.5%,55/57)and the combined group(98.2%,56/57).The MB group(84.2%,48/57)was statistically different from the ICG group(χ^2=4.930,P=0.026)and the combined group(χ^2=5.371,P=0.020).In terms of the number of SLN detected,the ICG group and combined group were superior to the MB group(3.5±1.0 vs.2.6±1.4,P=0.000;3.3±1.2 vs.2.6±1.4,P=0.001),and there was no statistical difference between the ICG group and the combined group(3.5±1.0 vs.3.3±1.2,P=0.484).The accuracy rate was 98.2%(54/55)in the ICG group,98.2%(55/56)in the combined group,and 93.8%(45/48)in the MB group,without significant statistical differences among the three groups(χ^2=2.177,P=0.337).The false negative rate was 3.8%(1/26)in the ICG group,4.5%(1/22)in the combined group,and 14.3%(3/21)in the MB group.There were no statis

关 键 词：乳腺肿瘤 前哨淋巴结活检 示踪剂 吲哚菁绿 亚甲蓝 

分 类 号：R73[医药卫生—肿瘤]