熒光法在乳腺癌前哨淋巴結活檢中的應用價值_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 劉慧民 , 白海亞 , 楊萍 , 龔曉軍 , 盧俊陽

甘肅省婦幼保健院乳腺二科（甘肅蘭州 730050）;

Corresponding?author：

劉慧民, Email: 2871395107@qq.com

Keywords：

熒光法; 吲哚菁綠; 乳腺癌; 前哨淋巴結活檢; 腋窩淋巴結清掃

DOI：

10.7507/1007-9424.20150289

Video：

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目的探討熒光法在乳腺癌患者前哨淋巴結活檢（SLNB）中的應用價值。方法前瞻性收集2014年5月至2015年2月期間甘肅省婦幼保健院收治的乳腺癌患者36例，通過于乳暈處皮內及皮下組織內注射吲哚菁綠（ICG）熒光示蹤劑，動態引導定位尋找前哨淋巴結（SLN），分析ICG的示蹤效果和SLNB對腋窩淋巴結轉移狀態的預測效果。結果 36例患者均成功行SLNB，SLN檢出率為100%；共檢出SLN 86枚，1～3枚/例，平均2.39枚/例；從皮膚切開至取出SLN的手術時間為3～22 min，平均9 min。術中冰凍病理學檢查示16例有SLN癌轉移，20例無SLN癌轉移；1例術中冰凍病理學檢查示無SLN癌轉移者，術后石蠟切片病理學檢查示有SLN癌轉移。ICG示蹤下SLNB的靈敏度為94.1%（16/17），假陰性率為5.9%（1/17）。結論熒光法動態引導定位用于乳腺癌SLNB，具有定位準確、檢出率高及創傷小的優勢，能較準確地預測乳腺癌患者腋窩淋巴結的狀態。

Citation： 劉慧民, 白海亞, 楊萍, 龔曉軍, 盧俊陽. 熒光法在乳腺癌前哨淋巴結活檢中的應用價值. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(9): 1118-1120. doi: 10.7507/1007-9424.20150289 Copy

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2.	王永勝. 乳腺癌前哨淋巴結活檢:共識與展望. 中國普外基礎與臨床雜志, 2009, 16(7):505-509.
3.	陳登峰. 前哨淋巴結活檢對早期乳腺癌患者腋窩淋巴結轉移狀況的預測. 中國普通外科雜志, 2014, 23(11):1590-1592.
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6.	顏寧, 劉少杰, 彭偉強, 等. 早期乳腺癌前哨淋巴結活檢對預測腋窩淋巴結狀態的臨床探討. 當代醫學, 2013, 19(1):107-108.
7.	趙玲, 陳文林, 徐忠能. 乳腺癌新輔助化療后前哨淋巴結活檢的臨床意義. 中國腫瘤臨床與康復, 2013, 20(3):242-244.
8.	喬江華, 焦得闖, 盧振鐸, 等. 術前淋巴結顯像在乳腺癌前哨淋巴結活檢中的應用價值. 中國腫瘤, 2014, 23(4):346-348.
9.	張毅, 楊新華, 范淋軍, 等. 腔鏡下乳腺癌前哨淋巴結活檢臨床應用及效果分析. 中國普外基礎與臨床雜志, 2012, 19(9):930-933.
10.	Motomura K, Inaji H, Komoike Y, et al. Sentinel node biopsy guided by indocyanine green dye in breast cancer patients. Jpn J Clin Oncol, 1999, 29(12):604-607.
11.	Murawa D, Hirche C, Dresel S, et al. Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence. Br J Surg, 2009, 96(11):1289-1294.
12.	Tagaya N, Yamazaki R, Nakagawa A, et al. Intraoperative identifica-tion of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer. Am J Surg, 2008, 195(6):850-853.
13.	Hirche C, Murawa D, Mohr Z, et al. ICG fluorescence-guided sentinel lymph node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat, 2010, 121(2):373-378.
14.	黃林平, 劉軍. 熒光法前哨淋巴結活檢在早期乳腺癌中的應用(附文獻復習). 中日友好醫院學報, 2013, 27(4):195-199.
15.	Mieog JS, Troyan SL, Hutteman M, et al. Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer. Ann Surg Oncol, 2011, 18(9):2483-2491.
16.	Tagaya N, Nakagawa A, Abe A, et al. Non-invasive identification of sentinel lymph nodes using indocyanine green fluorescence imaging in patient with breast cancer. Open Surg Oncol J, 2010, 2(2):71-74.
17.	Tagaya N, Aoyagi H, Nakagawa A, et al. A novel approach for sentinel lymph node identification using fluorescence imaging and image overlay navigation surgery in patients with breast cancer. World J Surg, 2011, 35(1):154-158.
18.	Guo W, Zhang L, Ji J, et al. Breast cancer sentinel lymph node mapping using near-infrared guided indocyanine green in comparison with blue dye. Tumour Biol, 2014, 35(4):3073-3078.
19.	Verbeek FP, Troyan SL, Mieog JS, et al. Near-infrared fluorescence sentinel lymph node mapping in breast cancer:a multicenter experience. Breast Cancer Res Treat, 2014, 143(2):333-342.
20.	黃勝超, 陳小東, 丁洪飛, 等. 早期浸潤性乳腺癌前哨淋巴結活檢術學習曲線分析. 中國普通外科雜志, 2013, 22(11):1410-1413.

1. ?Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis:a randomized clinical trial. JAMA, 2011, 305(6):569-575.
2. 王永勝. 乳腺癌前哨淋巴結活檢:共識與展望. 中國普外基礎與臨床雜志, 2009, 16(7):505-509.
3. 陳登峰. 前哨淋巴結活檢對早期乳腺癌患者腋窩淋巴結轉移狀況的預測. 中國普通外科雜志, 2014, 23(11):1590-1592.
4. 汪滿金, 俸瑞發. 乳腺癌前哨淋巴結活檢的研究進展. 中國普外基礎與臨床雜志, 2014, 21(12):1587-1592.
5. Yi M, Kuerer HM, Mittendorf EA, et al. Impact of the American college of surgeons oncology group Z0011 criteria applied to a contemporary patient population. J Am Coll Surg, 2013, 216(1):105-113.
6. 顏寧, 劉少杰, 彭偉強, 等. 早期乳腺癌前哨淋巴結活檢對預測腋窩淋巴結狀態的臨床探討. 當代醫學, 2013, 19(1):107-108.
7. 趙玲, 陳文林, 徐忠能. 乳腺癌新輔助化療后前哨淋巴結活檢的臨床意義. 中國腫瘤臨床與康復, 2013, 20(3):242-244.
8. 喬江華, 焦得闖, 盧振鐸, 等. 術前淋巴結顯像在乳腺癌前哨淋巴結活檢中的應用價值. 中國腫瘤, 2014, 23(4):346-348.
9. 張毅, 楊新華, 范淋軍, 等. 腔鏡下乳腺癌前哨淋巴結活檢臨床應用及效果分析. 中國普外基礎與臨床雜志, 2012, 19(9):930-933.
10. Motomura K, Inaji H, Komoike Y, et al. Sentinel node biopsy guided by indocyanine green dye in breast cancer patients. Jpn J Clin Oncol, 1999, 29(12):604-607.
11. Murawa D, Hirche C, Dresel S, et al. Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence. Br J Surg, 2009, 96(11):1289-1294.
12. Tagaya N, Yamazaki R, Nakagawa A, et al. Intraoperative identifica-tion of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer. Am J Surg, 2008, 195(6):850-853.
13. Hirche C, Murawa D, Mohr Z, et al. ICG fluorescence-guided sentinel lymph node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat, 2010, 121(2):373-378.
14. 黃林平, 劉軍. 熒光法前哨淋巴結活檢在早期乳腺癌中的應用(附文獻復習). 中日友好醫院學報, 2013, 27(4):195-199.
15. Mieog JS, Troyan SL, Hutteman M, et al. Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer. Ann Surg Oncol, 2011, 18(9):2483-2491.
16. Tagaya N, Nakagawa A, Abe A, et al. Non-invasive identification of sentinel lymph nodes using indocyanine green fluorescence imaging in patient with breast cancer. Open Surg Oncol J, 2010, 2(2):71-74.
17. Tagaya N, Aoyagi H, Nakagawa A, et al. A novel approach for sentinel lymph node identification using fluorescence imaging and image overlay navigation surgery in patients with breast cancer. World J Surg, 2011, 35(1):154-158.
18. Guo W, Zhang L, Ji J, et al. Breast cancer sentinel lymph node mapping using near-infrared guided indocyanine green in comparison with blue dye. Tumour Biol, 2014, 35(4):3073-3078.
19. Verbeek FP, Troyan SL, Mieog JS, et al. Near-infrared fluorescence sentinel lymph node mapping in breast cancer:a multicenter experience. Breast Cancer Res Treat, 2014, 143(2):333-342.
20. 黃勝超, 陳小東, 丁洪飛, 等. 早期浸潤性乳腺癌前哨淋巴結活檢術學習曲線分析. 中國普通外科雜志, 2013, 22(11):1410-1413.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

熒光法在乳腺癌前哨淋巴結活檢中的應用價值

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