Takao Yuko, Toh Uhi, Sakurai Sayaka, Saku Shuko, Takenaka Miki, Akashi Momoko, Sugihara Rie, Ogo Etsuyo, Akagi Yoshito
Dept. of Surgery, Kurume University School of Medicine.
Gan To Kagaku Ryoho. 2020 Aug;47(8):1225-1227.
Clinical evidence has indicated that, after neo-adjuvant chemotherapy(NAC), sentinel node(SN)identification rates(IR) were lower and false-negative rates(FNR)were higher for patients(pts)with local advanced breast cancer(BC)than for pts with early stage BC who did not receive NAC. Our previous clinical trial indicated that the real-time indocyanin green (RT-ICG)fluorescence imaging technique could improve the diagnostic sensitivity and detection accuracy of sentinel node biopsy(SNB). Nine pts with histologically confirmed Stage ⅡA to ⅢB, T1-T3, N0-2, M0 BC were selected to receive NAC, and the standard surgeries were performed after NAC completion. The SNs were detected by using conventional procedures with the blue dye(indigo carmine)plus 99mTc radioisotope techniques combined with concurrent RT-ICG. Clinically positive nodes were diagnosed by the radiologists using axillary ultrasound, MRI, and/or CT scans. All pts provided written informed consent before surgery. The surgical SNB was guided via RT-ICG fluorescence under standard light conditions by using the HEMS imaging system as previously published. All pts underwent SNB followed by completion node dissection(CND). The IR and FNR were calculated by comparing the results of the SNB and the histopathology of the resection specimens obtained via CND. The IR and FNR for each procedure of SNB were, respectively, 35.3% and 41.7% when indigo carmine blue was used, 82.4% and 0 when ICG fluorescence was used, and 58.8% and 5% when RI was used. In contrast, the total calculation of the triple tracer showed that IR reached 100% and FNR was 0. These data suggest that IR and FNR of SNB might be improved in pts with BC treated with NAC by using the novel triple tracer technique.
临床证据表明，新辅助化疗（NAC）后，局部晚期乳腺癌（BC）患者的前哨淋巴结（SN）识别率（IR）低于未接受NAC的早期BC患者，假阴性率（FNR）则更高。我们之前的临床试验表明，实时吲哚菁绿（RT-ICG）荧光成像技术可提高前哨淋巴结活检（SNB）的诊断敏感性和检测准确性。选取9例组织学确诊为ⅡA至ⅢB期、T1-T3、N0-2、M0 BC的患者接受NAC，NAC完成后进行标准手术。采用传统方法，即蓝色染料（靛胭脂）加99mTc放射性同位素技术并结合同步RT-ICG来检测SN。放射科医生通过腋窝超声、MRI和/或CT扫描诊断临床阳性淋巴结。所有患者在手术前均提供了书面知情同意书。如先前发表的那样，使用HEMS成像系统在标准光照条件下通过RT-ICG荧光引导进行手术SNB。所有患者均接受SNB，随后进行完全淋巴结清扫（CND）。通过比较SNB结果与经CND获得的切除标本的组织病理学结果来计算IR和FNR。使用靛胭脂时，SNB各步骤的IR和FNR分别为35.3%和41.7%；使用ICG荧光时，分别为82.4%和0；使用放射性同位素（RI）时，分别为58.8%和5%。相比之下，三种示踪剂的总体计算结果显示IR达到100%，FNR为0。这些数据表明，采用新型三联示踪剂技术可能会提高接受NAC治疗的BC患者的SNB的IR和FNR。
