荧光法在乳腺癌前哨淋巴结活检中的应用价值_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 刘慧民 , 白海亚 , 杨萍 , 龚晓军 , 卢俊阳

甘肃省妇幼保健院乳腺二科（甘肃兰州 730050）;

Corresponding author：

刘慧民, Email: 2871395107@qq.com

Keywords：

荧光法; 吲哚菁绿; 乳腺癌; 前哨淋巴结活检; 腋窝淋巴结清扫

DOI：

10.7507/1007-9424.20150289

Video：

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目的探讨荧光法在乳腺癌患者前哨淋巴结活检（SLNB）中的应用价值。方法前瞻性收集2014年5月至2015年2月期间甘肃省妇幼保健院收治的乳腺癌患者36例，通过于乳晕处皮内及皮下组织内注射吲哚菁绿（ICG）荧光示踪剂，动态引导定位寻找前哨淋巴结（SLN），分析ICG的示踪效果和SLNB对腋窝淋巴结转移状态的预测效果。结果 36例患者均成功行SLNB，SLN检出率为100%；共检出SLN 86枚，1～3枚/例，平均2.39枚/例；从皮肤切开至取出SLN的手术时间为3～22 min，平均9 min。术中冰冻病理学检查示16例有SLN癌转移，20例无SLN癌转移；1例术中冰冻病理学检查示无SLN癌转移者，术后石蜡切片病理学检查示有SLN癌转移。ICG示踪下SLNB的灵敏度为94.1%（16/17），假阴性率为5.9%（1/17）。结论荧光法动态引导定位用于乳腺癌SLNB，具有定位准确、检出率高及创伤小的优势，能较准确地预测乳腺癌患者腋窝淋巴结的状态。

Citation： 刘慧民, 白海亚, 杨萍, 龚晓军, 卢俊阳. 荧光法在乳腺癌前哨淋巴结活检中的应用价值. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(9): 1118-1120. doi: 10.7507/1007-9424.20150289 Copy

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.	王永胜. 乳腺癌前哨淋巴结活检:共识与展望. 中国普外基础与临床杂志, 2009, 16(7):505-509.
3.	陈登峰. 前哨淋巴结活检对早期乳腺癌患者腋窝淋巴结转移状况的预测. 中国普通外科杂志, 2014, 23(11):1590-1592.
4.	汪满金, 俸瑞发. 乳腺癌前哨淋巴结活检的研究进展. 中国普外基础与临床杂志, 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.	颜宁, 刘少杰, 彭伟强, 等. 早期乳腺癌前哨淋巴结活检对预测腋窝淋巴结状态的临床探讨. 当代医学, 2013, 19(1):107-108.
7.	赵玲, 陈文林, 徐忠能. 乳腺癌新辅助化疗后前哨淋巴结活检的临床意义. 中国肿瘤临床与康复, 2013, 20(3):242-244.
8.	乔江华, 焦得闯, 卢振铎, 等. 术前淋巴结显像在乳腺癌前哨淋巴结活检中的应用价值. 中国肿瘤, 2014, 23(4):346-348.
9.	张毅, 杨新华, 范淋军, 等. 腔镜下乳腺癌前哨淋巴结活检临床应用及效果分析. 中国普外基础与临床杂志, 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.	黄林平, 刘军. 荧光法前哨淋巴结活检在早期乳腺癌中的应用(附文献复习). 中日友好医院学报, 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.	黄胜超, 陈小东, 丁洪飞, 等. 早期浸润性乳腺癌前哨淋巴结活检术学习曲线分析. 中国普通外科杂志, 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. 王永胜. 乳腺癌前哨淋巴结活检:共识与展望. 中国普外基础与临床杂志, 2009, 16(7):505-509.
3. 陈登峰. 前哨淋巴结活检对早期乳腺癌患者腋窝淋巴结转移状况的预测. 中国普通外科杂志, 2014, 23(11):1590-1592.
4. 汪满金, 俸瑞发. 乳腺癌前哨淋巴结活检的研究进展. 中国普外基础与临床杂志, 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. 颜宁, 刘少杰, 彭伟强, 等. 早期乳腺癌前哨淋巴结活检对预测腋窝淋巴结状态的临床探讨. 当代医学, 2013, 19(1):107-108.
7. 赵玲, 陈文林, 徐忠能. 乳腺癌新辅助化疗后前哨淋巴结活检的临床意义. 中国肿瘤临床与康复, 2013, 20(3):242-244.
8. 乔江华, 焦得闯, 卢振铎, 等. 术前淋巴结显像在乳腺癌前哨淋巴结活检中的应用价值. 中国肿瘤, 2014, 23(4):346-348.
9. 张毅, 杨新华, 范淋军, 等. 腔镜下乳腺癌前哨淋巴结活检临床应用及效果分析. 中国普外基础与临床杂志, 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. 黄林平, 刘军. 荧光法前哨淋巴结活检在早期乳腺癌中的应用(附文献复习). 中日友好医院学报, 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. 黄胜超, 陈小东, 丁洪飞, 等. 早期浸润性乳腺癌前哨淋巴结活检术学习曲线分析. 中国普通外科杂志, 2013, 22(11):1410-1413.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

荧光法在乳腺癌前哨淋巴结活检中的应用价值

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