天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (1): 51-55.doi: 10.11958/20171012

• 临床研究 • 上一篇    下一篇

吲哚菁绿荧光导航技术联合纳米炭在早期乳腺癌前哨 淋巴结活检中的应用价值

周丹 1，张昆 1，陈佩贤 1，叶国麟 1△，吴爱国 2   

  1. 1 中山大学附属佛山医院，佛山市第一人民医院乳腺外科（邮编 528100）；2 南方医科大学珠江医院普通外科
  • 收稿日期:2017-10-09 修回日期:2017-11-08 出版日期:2018-01-15 发布日期:2018-01-16
  • 通讯作者: 叶国麟 E-mail:zhoudanms@sina.com
  • 作者简介:周丹（1980），男，副主任医师，博士，主要从事乳腺癌临床及分子基础的研究
  • 基金资助:
    广东省医学科研基金;纳米碳联合应用吲哚菁绿荧光导航技术行乳腺癌前哨 淋巴结活检的临床研究

Clinical value of indocyanine green fluorescence navigation combined with carbon nanoparticles in sentinel lymph node biopsy for patients with early breast cancer

ZHOU Dan1, ZHANG Kun1, CHEN Pei-xian1, YE Guo-lin1△, WU Ai-guo2   

  1. 1 Department of Breast Surgery, Foshan Hospital Affiliated to Sun Yat-Sen University, Foshan 528100, China; 2 Department of General Surgery, Zhujiang Hospital Affiliated to Southern Medical University
  • Received:2017-10-09 Revised:2017-11-08 Published:2018-01-15 Online:2018-01-16

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摘要： 目的 探讨吲哚菁绿（ICG）导航技术联合纳米炭混悬液（CNP）在早期乳腺癌前哨淋巴结活检（SLNB）中的 应用价值和优势。方法 回顾性分析 2013 年 6 月—2016 年 4 月在中山大学附属佛山医院行 SLNB 的 294 例腋窝 淋巴结阴性的早期乳腺癌患者的资料，其中采用 ICG 联合 CNP 示踪 149 例（联合组），美蓝示踪 145 例（美蓝组）。前 哨淋巴结（SLNs）未转移者免除腋窝清扫术（ALND），转移者即刻行 ALND。比较 2 组患者中 SLNs 的检出率、检出数 目及转移性 SLNs 的检出情况，分析年龄及体质量指数（BMI）对 SLNs 检出率的影响。结果 联合组皮肤淋巴管显影 率为 97.3%（145/149），淋巴结显影率为 95.9％（143/149）。联合组的 SLNs 检出率高于对照组（97.9% vs. 91.0%，χ2= 6.902，P＜0.05）。联合组 SLNs 平均检出数量多于美蓝组［（4.5±1.6）枚 vs. （3.2±1.5）枚，t=4.476，P＜0.05］。联合组共 检出 SLNs 715 枚，其中转移淋巴结 58 枚（8.1%），美蓝组共检出 544 枚，其中转移淋巴结 26 枚（4.7%），联合组转移 性 SLNs 检出率高于美蓝组（χ2=13.714，P＜0.01）。年龄、BMI 并不影响 2 组 SLNs 的检出率和转移检出率。结论 吲哚菁绿荧光导航技术联合纳米炭实施乳腺癌前哨淋巴结活检的稳定性和可操作性较强，检出率高，可作为实施 SLNB 的新方法。

关键词: 乳腺肿瘤, 前哨淋巴结活组织检查, 淋巴结切除术, 吲哚菁绿, 纳米炭, 荧光导航, 美蓝

Abstract: Objective To explore the clinical value of indocyanine green (ICG) fluorescence navigation combined with carbon nanoparticles (CNP) in sentinel lymph node biopsy (SLNB) for patients with early breast cancer. Methods A total of 294 early breast cancer patients with axillary node negative in Department of Breast Surgery, Foshan Hospital Affiliated to Sun Yat-Sen University from June 2013 to April 2016 were retrospectively analyzed. Of the patients, 149 cases underwent SLNB with ICG combined with CNP (combination group), while 145 cases underwent SLNB with methylene blue alone (MB group). If the intraoperative pathology results of sentinel lymph nodes (SLNs) were negative, axillary lymph node dissection (ALND) was avoided. The SLNs detection rate, detection number, metastatic SLNs detection rate in SLNB were compared between two groups. The influence of age and body mass index (BMI) on SLNs detection rate was also analyzed. Results In the combination group, subcutaneous lymphatic channels were successfully visualized in 145 patients, and the detection rate was 97.3% (145/149). The fluorescence of SLNs was successfully detected in 143 patients, and the detection rate was 95.9% (143/149). The detection rate of SLNs was higher in the combination group than that of methylene dye alone group (97.9% vs. 91.0%，χ2=6.902，P＜0.05). The average number of detected SLNs was higher in the combination group than that of methylene dye alone group (4.5±1.6 vs. 3.2±1.5，t=4.476，P＜0.05). Fifty-eight metastatic SLNs were found in 715 SLNs in the combination group (8.1%), and 26 in 544 SLNs in MB group (4.7%). The detection rate was significantly higher in the combination group than that of methylene dye alone group (χ2=13.714，P＜0.01). Age and BMI showed no influence on the detection rate and accuracy of SLNB in two groups (P > 0.05). Conclusion The combined tracing of ICG fluorescence and carbon nanoparticles for SLNB has showed a better stability and operability in patients with early breast cancer, which is recommended to be a new SLNB method.

Key words: breast neoplasms, sentinel lymph node biopsy, lymph node excision, indocyanine green, carbon nanoparticle, fluorescence navigation, methylene blue