上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (12): 1634-.doi: 10.3969/j.issn.1674-8115.2017.12.009?

• 论著（基础研究） • 上一篇    下一篇

吲哚菁绿在乳腺癌前哨淋巴结活检中的应用及其量效分析

叶欣 1，崔嵘嵘 2，周晓云 1，王铮元 2   

  1. 1. 上海交通大学 医学院附属国际和平妇幼保健院乳腺科，上海 200030；2. 同济大学附属杨浦医院乳腺外科，上海 200090
  • 出版日期:2017-12-28 发布日期:2018-01-10
  • 作者简介:叶欣（1984—），女，主治医师，硕士；电子信箱：yexin1148@hotmail.com
  • 基金资助:
    同济大学附属杨浦医院院级课题（Ser1201522）；上海交通大学医学院附属国际和平妇幼保健院院级课题（Jes150354）

Application of indocyanine green in sentinel lymph node biopsy of breast cancer and analysis of dose-response#br#

YE Xin1, CUI Rong-rong2, ZHOU Xiao-yun1, WANG Zheng-yuan2   

  1. 1. Department of Breast Surgery, The International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; 2. Department of Breast Surgery, Yangpu Hospital, Tongji University, Shanghai 200090, China
  • Online:2017-12-28 Published:2018-01-10
  • Supported by:
    Project of Yangpu Hospital, Tongji University, Ser1201522; Project of the International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai Jiao Tong University School of Medicine, Jes150354

PDF (PC)

1560

摘要： 目的 · 研究不同浓度的吲哚菁绿（ICG）在前哨淋巴结活检（SLNB）中皮下淋巴管及淋巴结的显影情况，寻找最佳浓度以提 高 SLNB 的成功率。方法 · 选择2015 年 1 月—2017 年 5 月临床腋窝淋巴结阴性的原发性乳腺癌患者339 例，采用ICG 和亚甲蓝双 示踪法行 SLNB。浓度为 1.25 mg/mL 的 ICG 原液，稀释至不同浓度，注射体积 1 mL；亚甲蓝注射 1 mL（10 mg/mL）。记录注射不同 浓度的ICG 后，皮下淋巴管、淋巴结的显影情况及 SLNB 成功率。结果 · ICG 浓度对淋巴管及淋巴结显影率和最终活检成功率有影 响（P=0.001）。在肿瘤位于乳房非外上象限（穿刺活检或手术切除活检）及肿瘤位于外上象限未行切除活检（穿刺活检）组中，达到 80% 的皮下淋巴管显影率的 ICG 浓度为 0.723 mg/mL（95% CI 为 0.595 ～ 0.915 mg/mL）。该浓度范围在这组患者中皮下淋巴结显影率 为 28% ～ 53%，SLNB 成功率为 88% ～ 92%；在肿瘤位于外上象限且已切除组中，皮下淋巴管和淋巴结显影率分别为 50% ～ 69% 和 20% ～ 42%，SLNB 成功率为 76% ～ 81%。2 组的皮下淋巴管显影率差异有统计学意义（P=0.014），淋巴结显影及 SLNB 成功率差异 无统计学意义（P=0.628，P=0.232）。 结论 · ICG 荧光法 + 亚甲蓝染色法的双示踪法行 SLNB 简单易行且活检成功率高，ICG 最佳浓 度为 0.723 mg/mL，可提高淋巴管及淋巴结的显影率。

关键词: 乳腺肿瘤, 前哨淋巴结活检, 示踪剂, 吲哚菁绿

Abstract:

Objective · To study the imaging of subcutaneous lymph-vessels and lymph-nodes in sentinel lymph node biopsy (SLNB) with different concentrations of indocyanine green (ICG), and to find the best concentration to improve the success rate of SLNB.   Methods · A total of 339 primary breast cancer patients with clinical negative axillary lymph node were enrolled in the study. Double tracer method [ICG and methylene blue (10 mg/ mL)] was used for sentinel lymph node biopsy. 1.25 mg/mL ICG was diluted to difference concentration. The injection volume was 1 mL for ICG and 1 mL for methylene blue. The imaging of subcutaneous lymph-vessels and lymph-nodes and the success rate of SLNB were recorded after injection of different concentrations of ICG.  Results · The concentration of ICG had significant effect on lymph-vessels and lymph-nodes imaging rate and SLNB success rate (P=0.001). In the group that breast tumors not located in the external upper quadrant (needle biopsy or excisional biopsy) and tumor located in the external upper quadrant without excisional biopsy (needle biopsy), concentration of ICG reached 80% subcutaneous lymph-vessels imaging rate is 0.723 mg/mL (95% CI 0.595-0.915 mg/mL). In this group, in this concentration range, the imaging rate of subcutaneous lymph node was 28%-53%, and the success rate of SLNB was 88%-92%. In the group that breast tumors located in the external upper quadrant and had been resected, the imaging rate of subcutaneous lymph-vessels and lymph-nodes was 50%-69% and 20%-42%, respectively, and the success rate of SLNB was 76%-81%. The difference of subcutaneous lymph-vessels imaging rate between two groups was statistically significant (P=0.014), but the difference of lymph-nodes imaging rate and SLNB success rate had no significance (P=0.628, P=0.232).  Conclusion · Using double tracer (ICG and methylene blue) in SLNB is simple and feasible. The best concentration of ICG is 0.723 mg/mL, which can improve the imaging rate of lymph nodes and lymph nodes.

Key words: breast cancer, sentinel lymph node biopsy, tracer, indocyanine green