近红外荧光法联合美蓝染料法在早期乳腺癌SLNB中的应用

摘要

目的 探讨近红外荧光法联合美蓝染料法在早期乳腺癌前哨淋巴结活组织检查(SL-NB)中的应用价值.方法 应用近红外荧光法和美蓝染料法对141例临床腋窝淋巴结检查阴性的早期原发性乳腺癌患者行SLNB,记录单用近红外荧光法或美蓝染料法以及联合2种方法检出前哨淋巴结(SLN)的数目和检出率,比较联合法检出的SLN术中冰冻病理检查与术后石蜡病理检查结果,分析BMI对近红外荧光法检出SLN情况的影响.结果 141例中近红外荧光法检出SLN(2.78±1.28)枚/人,优于美蓝染料法检出的(2.29±1.31)枚/人(t=4.640,P＜0.01),两者检出率比较差异有统计学意义(x2=4.083,P=0.039);联合法检出SLN(3.11±1.30)枚/人,优于美蓝染料法(t=10.360,P＜0.01),两者检出率比较差异有统计学意义(x2 =8.100,P=0.002).联合法检出的140例SLN术中冰冻病理检查与术后石蜡病理检查阳性率比较差异无统计学意义(x2=0.250,P=0.625).BMI ≥24 kg/m2者共86例(61.0％),近红外荧光法中共3例未测出发荧光的SLN,而BMI＜ 24 kg/m2者的近红外荧光法SLN检出率为100％.结论 近红外荧光法联合美蓝染料法可提高SLN的检出率和检出数目,提高SLNB的准确性,但如何提高肥胖患者的检出率是值得进一步研究的问题.%Objective To investigate the clinical value of near-infrared fluorescent method combined with methylene blue method for sentinel lymph node biopsy (SLNB) in patients with early breast cancer.Methods In total,141 patients diagnosed with early primary breast cancer who were negative for armpit lymph node examination received SLNB by near-infrared fluorescent method combined with methylene blue method.The quantity and detection rate of sentinel lymph node (SLN) by near-infrared fluorescent method or methylene blue method alone and combined application of two methods were recorded.Pathological examination of intraoperative frozen sections and postoperative paraffin-embedded sections were compared,evaluate the effect of BMI upon the detection results of SLN by near-infrared fluorescent method.Results The mean quantity of SLN detected by near-infrared fluorescent method was (2.78 ± 1.28),significantly higher compared with (2.29 ± 1.31) by methylene blue method (t =4.640,P ＜ 0.01).The detection rate of SLN significantly differed between two methods (x2 =4.083,P =0.039).The average quantity of SLN detected by combined methods was (3.11 ± 1.30),significantly higher than that detected by methylene blue method alone (t =10.360,P ＜ 0.01).The detection rate of SLN also significantly differed between two approaches (x2 =8.100,P =0.002).For the SLN detected by the combined methods in 140 cases,the positive rate between intraoperative frozen sections and postoperative paraffin-embedded sections did not significantly differ (x2 =0.250,P =0.625).For 86 patients with BMI≥24 kg/m2,SLN was not detected in 3 cases by near-infrared fluorescent method alone,whereas the detection rate was up to 100％ for those with BMI ＜24 kg/m2.Conclusion Combined application of near-infrared fluorescent method and methylene blue method can enhance the detection rate and quantity of SLN and increase the accuracy of SLNB.However,how to enhance the detection rate of SLN for obese patients remains to be investigated.