吲哚菁绿联合亚甲蓝在乳腺癌前哨淋巴结活检中的临床应用价值

发布时间：2018-05-24 07:55

本文选题：乳腺癌 + 前哨淋巴结活检　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景随着人们对乳腺癌的生物学特性的不断研究和认识,乳腺癌手术范围逐渐缩小。前哨淋巴结活检(sentinel lymph node biopsy,SLNB)作为一种乳腺癌微创手术的方式,逐渐广泛的应用于临床,SLNB在保持与腋窝淋巴结清扫(axillary lymph node dissection,ALND)相似的治疗效果上,同时也减少了术后并发症,改善了患者的生活质量。目前SLNB的示踪法有染料法、核素法及联合法,不同的示踪法直接影响着SLNB的成功率、准确率及假阴性率,间接地影响着患者的预后。国内外指南推荐应用核素染料联合法,由于操作复杂,设备昂贵,存在放射性危险等原因,限制了其在国内基层医院的推广。国内染料法最常用的示踪剂是亚甲蓝,近年来荧光剂吲哚菁绿开始作为一种新型示踪剂应用于乳腺癌SLNB中,利用吲哚菁绿在近红外荧光系统下的特点,吲哚菁绿与亚甲蓝相比具有明显的优势,然而吲哚菁绿联合亚甲蓝的检出效果需要进一步的验证。目的通过吲哚菁绿联合亚甲蓝与单用亚甲蓝在乳腺癌SLNB中的对比,探讨这两者联合在乳腺癌SLNB中的临床应用价值。方法选择2015年1月至2016年8月在新乡市中心医院头颈乳腺外科行SLNB的乳腺癌患者120例,联合组46例:吲哚菁绿荧光法联合亚甲蓝法行SLNB;亚甲蓝组74例:单独应用亚甲蓝法行SLNB,吲哚菁绿注射于乳晕区皮内,亚甲蓝注射于乳晕区皮下,联合组在近红外荧光导航系统引导下及沿着蓝染淋巴管寻找前哨淋巴结,亚甲蓝组沿着蓝染淋巴管寻找前哨淋巴结,取下的所有前哨淋巴结均行快速冰冻活检及常规病理学检查,所有患者SLNB后行ALND。结果联合组SLNB的检出率、准确率、灵敏度、特异度、假阴性率、前哨淋巴结检出平均数分别是97.8%(45/46)、95.6%(43/45)、94.1%(16/17),96.4%(27/28),5.9%(1/17)、(3.1±0.9)枚/例,亚甲蓝组SLNB的检出率、准确率、灵敏度、特异度、假阴性率、前哨淋巴结检出平均数分别为86.5%(64/74)、90.6%(58/64)、87.5%(21/24),92.5%(37/40),12.5%(3/24),(2.1±0.7)枚/例,联合组的检出率、准确率、灵敏度、特异度及前哨淋巴结检出平均数高于亚甲蓝,假阴性率低于亚甲蓝组,两组间的检出率及前哨淋巴结检出平均数的差异均有统计学意义(P0.05),但两组间的准确率、灵敏度、特异度及假阴性率差异无统计学意义(P0.05)。结论1、本研究中,在乳腺癌SLNB中应用吲哚菁绿,在近红外荧光导航系统的引导下能够直观地显示淋巴管引流方向,准确定位前哨淋巴结的位置,降低了SLNB的盲目性,减轻了对组织的损伤。2、本研究通过对吲哚菁绿联合亚甲蓝与单用亚甲蓝的比较显示,在乳腺癌SLNB中,两者联合可以提高SLNB的检出率、前哨淋巴结检出个数,是一种很有前景的SLNB示踪法。
[Abstract]:Background with the continuous research and understanding of the biological characteristics of breast cancer, the scope of breast cancer surgery is gradually reduced. Sentinel lymph node biopsys SLNBs, as a minimally invasive procedure for breast cancer, have gradually been widely used in clinical practice to maintain similar therapeutic effects as axillary lymph node dissection to axillary lymph node dissection (ALND), and to reduce postoperative complications. Improved the patient's quality of life. At present, the tracer methods of SLNB include dye method, nuclide method and combination method. Different tracer methods directly affect the success rate, accuracy and false negative rate of SLNB, and indirectly affect the prognosis of patients. The domestic and foreign guidelines recommend the application of radionuclide dye combination method, because of the complex operation, expensive equipment and the existence of radioactive hazards, it is limited in the promotion of basic hospitals in China. Methylene blue is the most commonly used tracer in domestic dye method. In recent years, indocyanine green has been used as a new tracer in breast cancer SLNB, using the characteristics of indocyanine green in near infrared fluorescence system. Indocyanine green has obvious advantages over methylene blue, but the detection effect of indocyanine green combined with methylene blue needs further verification. Objective to evaluate the clinical value of indocyanine green combined with methylene blue and methylene blue in SLNB of breast cancer. Methods from January 2015 to August 2016, 120 patients with breast cancer underwent SLNB in the Department of head and neck Breast surgery, Xinxiang Central Hospital. 46 cases in the combined group were treated with SLNB by indocyanine green fluorescence method combined with methylene blue method, 74 cases in the methylene blue group were treated with SLNB by methylene blue alone, indocyanine green was injected into the skin of the areola area, methylene blue was injected subcutaneously in the areola area, The sentinel lymph nodes were found in the combined group under the guidance of the near infrared fluorescence navigation system and along the blue-stained lymphatic vessels, while in the methylene blue group the sentinel lymph nodes were searched along the blue-stained lymphatic vessels. All sentinel lymph nodes removed were examined by rapid frozen biopsy and routine pathological examination. All patients underwent ALND after SLNB. Results the detection rate, accuracy, sensitivity, specificity, false negative rate and sentinel lymph node detection average of SLNB in the combined group were 97.885 / 46, 95.643 / 45 / 94.41 / 17 / 96.40% and 5.9% / case / case, respectively. The detection rate, accuracy, sensitivity, specificity, false negative rate of SLNB in methylene blue group were 3.1 卤0.9 / case, and the detection rate, accuracy, sensitivity, specificity, false negative rate of SLNB in methylene blue group. The average number of sentinel lymph nodes detected was 86.5 / 74 / 90.60.58 / 64 / 87.5a / case, respectively. The false negative rate was lower than that of the methylene blue group, and the detection rate of the combined group was 2.1 卤0.7. The detection rate, accuracy, sensitivity, specificity and the average detection of the sentinel lymph nodes in the combined group were higher than those in the methylene blue group, and the false negative rate was lower than that in the methylene blue group. There were significant differences in the detection rate and the average number of sentinel lymph nodes between the two groups (P 0.05), but there was no significant difference in accuracy, sensitivity, specificity and false negative rate between the two groups. Conclusion 1. In this study, the application of indocyanine green in breast cancer SLNB can show the direction of lymphatic drainage intuitively under the guidance of near infrared fluorescence navigation system, locate the position of sentinel lymph nodes accurately, and reduce the blindness of SLNB. This study showed that the combination of indocyanine green and methylene blue could improve the detection rate of SLNB and the number of sentinel lymph nodes in breast cancer SLNB. It is a promising SLNB tracer method.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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