Ogasawara Yutaka, Ikeda Hirokuni, Takahashi Mina, Kawasaki Kensuke, Doihara Hiroyoshi
Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama-City, Okayama 700-8558, Japan.
World J Surg. 2008 Sep;32(9):1924-9. doi: 10.1007/s00268-008-9519-7.
In patients with early breast cancer, sentinel lymph node biopsy (SLNB) has been emerging as a new standard of care. The use of SLNB with a blue dye is convenient and safe, but it requires a high level of technical skill. Recently, an instrument that can provide fluorescence imaging of lymphatic flow has been introduced. In the present study, we analyzed breast lymphatic pathways and discussed its potential as a modality to complement the use of SLNB with a blue dye.
Thirty-seven consecutive patients with breast cancer were examined. To obtain fluorescence imaging, an invisible near-infrared fluorescence imaging system was used. After indocyanine green was subdermally injected in the subareolar site and at two sites around the tumor, the subcutaneous lymphatic drainage pathway (LDP) was observed.
In 27 (72.9%) of the patients, the number of LDP from the periareolar area was one or two. In 21(63.6%) of 33 patients with subdermal injection around the tumor, no LDP was observed from the peritumoral area. Lymphatic connection between the peritumoral area and the periareolar area was observed very frequently (91.7%). In 26 (70.3%) of the patients, multiple routes joined together and only one route was ultimately directed to the axilla. Significant correlation was seen between body mass index (BMI) and the transit time to the axilla after injection (p = 0.0038). Additionally, a significant correlation was seen between the number of LPD from the periareolar area and the distance between detected SLNs and the fluorescence line-disappearing point (p = 0.034).
This instrument can provide some important information, and can be an available and reliable navigator for SLNB with a blue dye.
在早期乳腺癌患者中，前哨淋巴结活检（SLNB）已逐渐成为一种新的标准治疗方法。使用蓝色染料进行SLNB操作简便且安全，但需要较高的技术水平。最近，一种能够提供淋巴流荧光成像的仪器被引入。在本研究中，我们分析了乳腺淋巴通路，并探讨了其作为补充蓝色染料SLNB的一种方式的潜力。
对37例连续的乳腺癌患者进行检查。为获得荧光成像，使用了一种不可见近红外荧光成像系统。在乳晕下部位及肿瘤周围的两个部位皮下注射吲哚菁绿后，观察皮下淋巴引流途径（LDP）。
27例（72.9%）患者中，来自乳晕周围区域的LDP数量为一或两条。在肿瘤周围皮下注射的33例患者中，21例（63.6%）未观察到来自肿瘤周围区域的LDP。肿瘤周围区域与乳晕周围区域之间的淋巴连接非常常见（91.7%）。26例（70.3%）患者中，多条路径汇合在一起，最终只有一条路径通向腋窝。体重指数（BMI）与注射后到达腋窝的转运时间之间存在显著相关性（p = 0.0038）。此外，来自乳晕周围区域的LPD数量与检测到的前哨淋巴结与荧光线消失点之间的距离存在显著相关性（p = 0.034）。
该仪器可以提供一些重要信息，并且可以成为使用蓝色染料进行SLNB的一种可用且可靠的导航工具。
