吲哚菁绿联合亚甲蓝染色在乳腺癌前哨淋巴结活检中的应用评估

Evaluation of indocyanine green combined with methylene blue staining in sentinel lymph node biopsy of breast cancer.

作者信息

Xu Yong, Yuan Songlin, Chen Mingtao, Gong Ke, Liu Youzhong, Li Shengyun, Xiong Fang, Pan Yuejun, Cao Jiyao, Gong Jia, Luo Na

机构信息

Department of Thyroid and Breast Surgery, Changde First People's Hospital, Changde, China.

出版信息

Gland Surg. 2022 Sep;11(9):1489-1496. doi: 10.21037/gs-22-434.

DOI:10.21037/gs-22-434

PMID:36221275

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9547706/

Abstract

BACKGROUND

Methylene blue as tracer used in sentinel lymph node biopsy (SLNB) have low detection rate and high false negative rate. Indocyanine green (ICG) can detect the flow of subcutaneous lymphatic vessels and the position of lymph nodes dynamically. This study sought to evaluate the efficacy of ICG combined with methylene blue staining in SLNB of breast cancer.

METHODS

One hundred and fifty-six early breast cancer patients treated at our hospital from July 2020 to May 2022 were enrolled in this study. SLNB was performed by ICG combined with methylene blue staining under the guidance of the fluorescent tracer navigation system FLI-10B. Standard axillary lymph node dissection (ALND) was performed in patients with sentinel lymph node (SLN) metastasis confirmed by intraoperative frozen pathology, while low ALND was performed in patients with negative SLNs. According to the staining condition, the SLNs were divided into: (I) the combined group (SLNs with methylene blue staining and/or ICG luminescence); (II) the methylene blue group (SLNs with methylene blue staining alone); and (III) the ICG group (SLNs with ICG luminescence alone). The detection rate, accuracy, sensitivity, and false negative rate of SLNB were compared among the 3 groups.

RESULTS

A total of 592 SLNs were detected in the combined group (average 3.8 SLNs), yielding a detection rate of 97.4%; the accuracy, sensitivity, and false negative rates were 97.4%, 92.7%, and 7.3%. In the methylene blue group, 390 SLNs were detected (average 2.5 SLNs), yielding a detection rate of 84.6%; the accuracy, sensitivity, and false negative rates were 83.3%, 89.1%, and 10.9%. A total of 483 SLNs were detected in the ICG group (average 3.1 SLNs), the detection rate was 92.9%; the accuracy, sensitivity and false negative rates were 91.7%, 90.9%, and 9.1%. The average number of detected SLNs, detection rate and accuracy rate in the combined group were higher than those in the methylene blue group (P<0.05), and the accuracy rate of the combined group was higher than that of the ICG group (P<0.05).

CONCLUSIONS

ICG combined with methylene blue staining is a promising and effective tracing strategy in the SLNB of breast cancer with high detection and accuracy rates.

摘要

背景

亚甲蓝作为前哨淋巴结活检（SLNB）中的示踪剂，检出率低且假阴性率高。吲哚菁绿（ICG）可动态检测皮下淋巴管的流动及淋巴结位置。本研究旨在评估ICG联合亚甲蓝染色在乳腺癌SLNB中的疗效。

方法

选取2020年7月至2022年5月在我院接受治疗的156例早期乳腺癌患者纳入本研究。在荧光示踪导航系统FLI - 10B引导下，采用ICG联合亚甲蓝染色进行SLNB。术中冰冻病理确诊前哨淋巴结（SLN）转移的患者行标准腋窝淋巴结清扫（ALND），SLN阴性的患者行低位ALND。根据染色情况，将SLN分为：（I）联合组（亚甲蓝染色和/或ICG发光的SLN）；（II）亚甲蓝组（仅亚甲蓝染色的SLN）；（III）ICG组（仅ICG发光的SLN）。比较3组SLNB的检出率、准确率、灵敏度和假阴性率。

结果

联合组共检测到592枚SLN（平均3.8枚SLN），检出率为97.4%；准确率、灵敏度和假阴性率分别为97.4%、92.7%和7.3%。亚甲蓝组检测到390枚SLN（平均2.5枚SLN），检出率为84.6%；准确率、灵敏度和假阴性率分别为83.3%、89.1%和10.9%。ICG组共检测到483枚SLN（平均3.1枚SLN），检出率为92.9%；准确率、灵敏度和假阴性率分别为91.7%、90.9%和9.1%。联合组的平均SLN检出数、检出率和准确率均高于亚甲蓝组（P<0.05），联合组的准确率高于ICG组（P<0.05）。