乳腺癌前哨淋巴结活检中亚甲蓝联合^(99m)Tc-硫胶体评估淋巴结转移  

Evaluation of methylene blue combined with ^(99m)Tc-sulfur colloid in sentinel lymph node biopsy of breast cancer for lymph node metastasis

作　　者：施莹莹 许淑萍 杨丽群 SHI Yingying;XU Shuping;YANG Liqun(Department of Breast Diseases,Affiliated Zhuhai Hospital of the Faculty of Chinese Medicine,Macao University of Science and Technology,Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine,Zhuhai,Guangdong 519000,China)

机构地区：[1]澳门科技大学中医药学院附属珠海医院、珠海市中西医结合医院乳腺病科,广东珠海519000

出　　处：《中国临床研究》2024年第10期1526-1529,1534,共5页Chinese Journal of Clinical Research

基　　金：珠海市社会发展领域科技计划项目(2320004000321)。

摘　　要：目的探讨^(99m)Tc-硫胶体(^(99m)Tc-SC)淋巴结显像联合亚甲蓝示踪在前哨淋巴结活检(SLNB)中的应用及其对腋窝淋巴结转移的评估意义及安全性。方法选取2017年12月至2022年12月于珠海市中西医结合医院收治的乳腺癌患者121例,随机分为亚甲蓝组(n=41)、^(99m)Tc-SC组(n=40)及联合组(n=40)。所有患者进行亚甲蓝、^(99m)Tc-SC核素显像或二者联合示踪行SLNB并随后行腋窝淋巴结清扫术(ALNB)。以ALND病理结果为准,分析三种方法对前哨淋巴结的诊断效能。结果结果显示,腋窝前哨淋巴结检出准确率、特异度、灵敏度、假阴性率方面三组之间差异无统计学意义(P>0.05)。腋窝阳性淋巴结检出个数在亚甲蓝组(2.79±0.98)、^(99m)Tc-SC组(3.25±1.25)和联合组(3.97±1.06)依次增加(F=11.78,P<0.01),两两比较,差异亦有统计学意义(P<0.05)。亚甲蓝组、联合组各发生4例、1例尿液蓝染,且所有患者在24 h内尿液颜色均恢复正常,未观察到其他不良反应。结论^(99m)Tc-SC联合亚甲蓝作为SLNB的示踪方法,能够提高腋窝阳性淋巴结检出个数,此方法在乳腺癌SLNB中具有较高的应用价值。Objective To investigate the application of ^(99m)Tc-sulfur colloid(^(99m)Tc-SC)lymph node imaging with methylene blue tracing during sentinel lymph node biopsy(SLNB)procedures and its importance in evaluating axillary lymph node metastasis and safety.Methods A total of 121 breast cancer patients admitted to Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from December 2017 to December 2022 were selected,and were randomly divided into the methylene blue group(n=41),the ^(99m)Tc-SC group(n=40)and combination group(n=40).All patients recevied SLNB under the tracing of methylene blue,^(99m)Tc-SC radionuclide imaging,or the combination of the two,and followed by axillary lymph node dissection.Based on the pathological results after SLNB,the diagnostic efficiency of three methods for sentinel lymph nodes was analyzed.Results There was no significant difference in the detection accuracy,specificity,sensitivity and false negative rate of axillary sentinel lymph nodes among the three groups(P>0.05).The detected number of axillary positive lymph nodes in methylene blue group(2.79±0.98),^(99m)Tc-SC group(3.25±1.25),and combination group(3.97±1.06)increased sequentially(F=11.78,P<0.01),and the differences of pairwise comparisons were also statistically significant(P<0.05).Urine blue staining occurred in 4 cases of methylene blue group and 1 case of combined group,and the urine color of all patients returned to normal within 24 hours,and no other adverse reaction was observed.Conclusion The combination of ^(99m)Tc-SC and methylene blue as a tracer can improve the detected number of axillary positive lymph nodes,which has high application value in SLNB of breast cancer.

关 键 词：亚甲蓝 ^(99m)Tc-硫胶体 前哨淋巴结活检 乳腺癌 淋巴结转移 

分 类 号：R737.9[医药卫生—肿瘤]