Wishart G C, Loh S-W, Jones L, Benson J R
Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ, UK.
Eur J Surg Oncol. 2012 Aug;38(8):651-6. doi: 10.1016/j.ejso.2012.05.007. Epub 2012 Jun 14.
There is now increasing evidence to support the use of indocyanine green (ICG) for sentinel lymph node (SLN) detection in early breast cancer. The primary objective of this feasibility study (ICG-10) was to determine the sensitivity and safety of ICG fluorescence imaging in sentinel lymph node identification when combined with blue dye and radiocolloid.
One hundred women with clinically node negative breast cancer (95 unilateral; 5 bilateral) had sentinel lymph node (SLN) biopsy using blue dye, radioisotope and ICG. One patient was excluded from analysis and sensitivity, or detection rate, of ICG alone, and in combination with blue dye and/or radioisotope, was calculated for the remaining 104 procedures in 99 patients.
Transcutaneous fluorescent lymphography was visible in all 104 procedures. All 202 true SLNs, defined as blue and/or radioactive, were also fluorescent with ICG. Detection rates were: ICG alone 100%, ICG & blue dye 95.0%, ICG & radioisotope 77.2%, ICG & blue dye & radioisotope 73.1%. Metastases were found in 25 of 201 SLNs (12.4%) and all positive nodes were fluorescent, blue and radioactive. The procedural node positivity rate was 17.3%.
The results of this study confirm the high sensitivity of ICG fluorescence for SLN detection in early breast cancer. The combination of ICG and blue dye had the highest nodal sensitivity at 95.0% defining a dual approach to SLN biopsy that avoids the need for radioisotope.
目前有越来越多的证据支持使用吲哚菁绿（ICG）进行早期乳腺癌前哨淋巴结（SLN）检测。本可行性研究（ICG - 10）的主要目的是确定ICG荧光成像与蓝色染料和放射性胶体联合用于前哨淋巴结识别时的敏感性和安全性。
100例临床腋窝淋巴结阴性的乳腺癌女性患者（95例单侧；5例双侧）接受了使用蓝色染料、放射性同位素和ICG的前哨淋巴结活检。1例患者被排除在分析之外，计算了其余99例患者104次手术中单独使用ICG以及与蓝色染料和/或放射性同位素联合使用时的敏感性或检出率。
在所有104次手术中均可见经皮荧光淋巴造影。所有202个真正的前哨淋巴结（定义为蓝色和/或有放射性）也都表现为ICG荧光阳性。检出率分别为：单独使用ICG时为100%，ICG与蓝色染料联合时为95.0%，ICG与放射性同位素联合时为77.2%，ICG与蓝色染料及放射性同位素联合时为73.1%。在201个前哨淋巴结中有25个（12.4%）发现转移，所有阳性淋巴结均为荧光阳性、蓝色和有放射性。手术的淋巴结阳性率为17.3%。
本研究结果证实了ICG荧光在前哨淋巴结检测中的高敏感性。ICG与蓝色染料联合使用时淋巴结敏感性最高，为95.0%，确定了一种避免使用放射性同位素的前哨淋巴结活检双重方法。
