吲哚菁绿联合光分子手术导航系统在乳腺癌前哨淋巴结活检中的临床应用

发布时间：2018-02-28 06:20

本文关键词： 乳腺癌前哨淋巴结活检吲哚菁绿亚甲蓝　出处：《中国人民解放军医学院》2015年硕士论文　论文类型：学位论文

【摘要】：背景：当前乳腺癌前哨淋巴结活检(SLNB)的方法主要有染料法、核素法及二者的联合,现行的方法各有其优缺点。国外指南推荐同时运用染料法和核素法以降低假阴性率,提高成功率。受多方面的制约,国内指南目前仅支持亚甲蓝法作为乳腺癌SLNB的首选。光学分子成像技术是目前生物医学研究领域的热点之一该技术使用荧光示踪剂特异性结合体内的生物大分子,通过专门的体外影像检测设备观察,使前哨淋巴结(SLN)产生穿透组织层的光学显影以实现实时手术导航的目的。该方法常使用吲哚菁绿(ICG)作为荧光示踪剂。研究认为,使用光学分子影像技术介导的ICG法实施乳腺癌SLNB较传统方法更具优势,但这种方法的广泛应用仍需更进一步的临床实验验证。目的：研究ICG联合光分子手术导航系统(SNS)在乳腺癌SLNB中的临床应用价值。方法：共入组初诊为乳腺癌并具备SLNB适应证的74例患者,在SNS的引导下,分别使用ICG和亚甲蓝、及单用ICG开展乳腺SLNB的研究。快速冰冻病理证实SLN转移者,接受腋窝淋巴结清扫(ALND); SLN阴性者免于ALND。对不同方法的平均检出个数、成功率、假阴性率、准确率、灵敏度等结果进行统计学分析。结果：在自身对照设计的39例临床实验中,ICG法成功率92.3%,共检出SLN 124个,平均3.18个,灵敏度100%,假阴性率为0%;亚甲蓝法成功率89.7%,共检出SLN71个,平均1.8个,灵敏度93.7%,假阴性率为6.3%; ICG法平均检出个数优于亚甲蓝法(p0.05)。成功率、假阴性率等主要观察指标非劣效于亚甲蓝法(一致性检验p0.05,差异性检验p0.05)。在单用ICG法的35例临床实验中,ICG法成功率94.3%,共检出SLN111个,平均3.17个,灵敏度100%,假阴性率0%。结论:ICG法实施乳腺癌SLNB成功率高,假阴性率低,手术操作直观可靠,准确性好,对术者手术经验依赖较少,易被手术医生掌握,可缩短学习曲线;临床效果不差于传统亚甲蓝法,值得深入研究和推广,有望普遍应用于乳腺癌SLNB。SNS在试用过程中,效果稳定,成像清晰,安全可靠,有效避免了传统手术操作的盲目性,预示了光分子影像技术在乳腺微创外科领域的良好应用前景。
[Abstract]:Background: at present, the methods of sentinel lymph node biopsy (SLNB) for breast cancer mainly include dye method, nuclide method and their combination. The current methods have their own advantages and disadvantages. Foreign guidelines recommend the use of dye method and nuclide method to reduce false negative rate. Increase success rates. Subject to multiple constraints, The domestic guidelines only support methylene blue method as the first choice for breast cancer SLNB. Optical molecular imaging is one of the hot topics in biomedical research. This technique uses fluorescent tracer to specifically bind biomolecules in vivo. In order to realize the aim of real-time operation navigation, the SLN (sentinel lymph node) was observed by a special imaging equipment in vitro. In this method, indocyanine green (ICG) was often used as a fluorescent tracer, and it was found that ICG was used as a fluorescent tracer. The ICG method mediated by optical molecular imaging technique has more advantages than the traditional method in the implementation of breast cancer SLNB. But the extensive application of this method still needs further clinical experiment verification. Objective: to study the clinical application value of ICG combined with photomolecular surgery navigation system in SLNB of breast cancer. 74 patients with SLNB indications, Under the guidance of SNS, the study of breast SLNB was carried out with ICG and methylene blue, and ICG alone. The patients with SLN metastasis received axillary lymph node dissection and those with SLN negative were exempted from ALND. The average number of detections and the success rate of different methods were obtained. Results: in 39 cases of self-control design, the success rate of SLN was 92.3%, and the SLN was 124, with an average of 3.18. Sensitivity 100, false negative rate 0; methylene blue method 89.7%, detection rate 1.8, sensitivity 93.7m, false negative rate 6.3%; ICG method average detection number better than methylene blue method p 0.05%. The main observation indexes such as false negative rate were not inferior to methylene blue (consistency test p 0.05, difference test P 0.05). In 35 clinical trials using ICG alone, the success rate of ICG method was 94.3%, and a total of 3.17 SLN111 were detected. The sensitivity is 100 and the false negative rate is 0.Conclusion the successful rate of SLNB in breast cancer is high, the false negative rate is low, the operation is intuitionistic and reliable, the accuracy is good, the operation experience is less, the operation is easy to be mastered by the surgeon, and the learning curve can be shortened. The clinical effect is not worse than that of the traditional methylene blue method, which is worthy of further study and popularization. It is expected to be widely used in the trial process of breast cancer SLNB.SNS. The effect is stable, the imaging is clear, the imaging is safe and reliable, and the blindness of the traditional surgical operation is effectively avoided. The prospect of the application of photomolecular imaging in breast minimally invasive surgery is predicted.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

【共引文献】