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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 498 -501. doi: 10.3877/cma.j.issn.1674-3946.2024.05.008

论著

吲哚菁绿荧光显影联合亚甲蓝染色在乳腺癌前哨淋巴结活检中的应用
宋佳1, 汪波1, 孙凯律1, 商江峰1, 吴旦平1,†(), 肇毅2   
  1. 1. 215500　江苏　常熟，常熟市第一人民医院甲乳外科
    2. 211000　南京，江苏省人民医院甲乳外科
  • 收稿日期:2023-10-24 出版日期:2024-10-26
  • 通信作者: 吴旦平

Application of indocyanine green fluorescence imaging combined with methylene blue staining in sentinel lymph node biopsy of breast cancer

Jia Song1, Bo Wang1, Kailu Sun1, Jiangfeng Shang1, Danping Wu1,†(), Yi Zhao2   

  1. 1. Department of Thoracic Surgery, the First People’s Hospital of Changshu City, Changshu Jiangsu Province 215500, China
    2. Department of Thyroid and Breast Surgery, Jiangsu Provincial People’s Hospital, Nanjing Jiangsu Province 211000 ,China
  • Received:2023-10-24 Published:2024-10-26
  • Corresponding author: Danping Wu
  • Supported by:
    Science and Technology Project of Changshu Municipal Health Commission in 2021(CSWS202111); 2020 Provincial TCM Science and Technology Development Plan Project(YB2020095)
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宋佳, 汪波, 孙凯律, 商江峰, 吴旦平, 肇毅. 吲哚菁绿荧光显影联合亚甲蓝染色在乳腺癌前哨淋巴结活检中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 498-501.

Jia Song, Bo Wang, Kailu Sun, Jiangfeng Shang, Danping Wu, Yi Zhao. Application of indocyanine green fluorescence imaging combined with methylene blue staining in sentinel lymph node biopsy of breast cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 498-501.

目的

探讨吲哚菁绿(ICG)和亚甲蓝(MB)联合应用于早期乳腺癌前哨淋巴结活检(SLNB)的可行性。

方法

回顾性分析2014年1月至2023年9月415例接受SLNB和腋窝淋巴结清扫术（ALND）的患者资料。根据不同染色方法分为MB+ICG组(n=197)和MB组(n=218)。数据分析用SPSS 26.0软件进行。SLNB检出率及假阴性率检验比较采用χ2检验，必要时进行Bonferroni校正。P<0.05差异有统计学意义。

结果

MB + ICG组SLN的检出率为96.9%，显著高于MB组的89.7% (P<0.05)。同样，联合组平均每例SLN数为3.0枚，明显高于MB组的2.1枚(P<0.05)。联合组和单用MB组的假阴性率分别为7.3%和10.5%，差异无统计学意义(P=0.791)。

结论

ICG和MB联合应用于SLNB较单独应用MB更能有效检测SLN。

关键词: 吲哚菁绿荧光显影, 亚甲蓝染色, 乳腺癌, 前哨淋巴结活检
Objective

To investigate the feasibility of combined application of indocyanine green (ICG) and methylene blue (MB) in sentinel lymph node biopsy (SLNB) of early breast cancer.

Methods

Data of 415 patients who underwent SLNB and axillary lymph node dissection from January 2014 to September 2023 were retrospectively analyzed. They were divided into MB + ICG group (n=197) and MB group (n=218) according to different staining methods. SPSS 26.0 software was used for data analysis. The detection rate and false negative rate of SLNB were compared by χ2 test, and Bonferroni correction was performed if necessary. P<0.05 was statistically significant.

Results

The detection rate of SLN in MB + ICG group was 96.9%, which was significantly higher than 89.7% in MB group (P<0.05). Similarly, the average SLN number per patient in the combined group was 3.0, which was significantly higher than 2.1 in the MB group (P<0.05). The false negative rates of the combined group and the MB group were 7.3% and 10.5%, respectively, with no significant difference (P=0.791).

Conclusion

ICG and MB combined in SLNB can detect SLN more effectively than MB alone.

Key words: Indocyanine Green Fluorescence Imaging, Methylene Blue Staining, Breast Cancer, Sentinel Lymph Node Biopsy
表1 两组患者一般资料对比
组别 例数 年龄(岁，) 已绝经（例） 体重指数(kg/m2，)
MB 218 46.7±11.2 77 22.1±2.0
MB+ICG 197 45.3±10.9 63 23.0±2.3
t/χ2值 1.792 2.581 1.886
P值 0.368 0.471 0.420
组别 例数 ER阳性（例） PR阳性（例） HER-2阳性（例）
MB 218 144 134 20
MB+ICG 197 135 129 17
t/χ2值 2.110 1.976 1.826
P值 0.590 0.396 0.454
表2 联合组与MB组SLN的检出率及平均数目比较
类别 MB MB+ICG P值
行SLNB检测（例） 218 197
检测到SLN（例） 196 191
SLN的检出率(%) 89.7 96.9 0.004
每个患者检测到的SLN(范围) 2.1(1-4) 3.0(1-6) 0.011
图1 前哨淋巴结(SLN)定位图像 注：A=发光的淋巴管及SLN；B=采用吲哚菁绿(ICG)+蓝染法检测SLN。
图2 病理证实的5个前哨淋巴结(SLN)的代表图像 注：A=用荧光脉管成像系统显示5枚SLN的荧光图像；B=切除后SLN的影像表现。
表3 联合组与MB组假阴性率的比较
组别 例数 实际有病人数+被判无病人数 实际有病而被判无病人数 假阴性率
MB+ICG 197 51 4 7.3
MB 218 51 6 10.5
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