吲哚氰绿荧光显影联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检中的效果对比

目的探讨吲哚氰绿(ICG)联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检(SLNB)中的效果差异。方法回顾性收集2017年6月到2019年2月期间于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗后行SLNB并同时行腋窝淋巴结清扫(ALND)的乳腺癌患者77例,其中通过ICG+亚甲蓝示踪行SLNB的乳腺癌患者46例(ICG+亚甲蓝组),通过核素+亚甲蓝示踪行SLNB的乳腺癌患者31例(核素+亚甲蓝组)。比较2组患者的示踪效果。结果 77例患者中至少检出1枚前哨淋巴结(SLN)者73例,SLN检出率为94.80%,其中ICG+亚甲蓝组43例,核素+亚甲蓝组30例。ICG+亚甲蓝组患者的NAC后前哨淋巴结检出率为93.48%(43/46),平均检出SLN 2.32枚/例,灵敏度为82.61%(19/23),假阴性率为17.39%(4/23),准确率为90.70%(39/43)。核素+亚甲蓝组的SLN检出率为96.77%(30/31),平均检出SLN 2.6枚/例,灵敏度为83.33%(10/12),假阴性率为16.67%(2/12),准确率为93.33%(28/30)。2组的SLN检出率、检出数目、灵敏度、假阴性率及准确率比较差异均无统计学意义(P0.05)。结论 ICG联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后的乳腺癌SLNB中具有相似的SLN检出率、SLN检出数目、灵敏度、准确率及假阴性率,可以推广实施。     

腔镜下乳腺癌前哨淋巴结活检临床应用及效果分析

目的探讨在腔镜下进行乳腺癌前哨淋巴结活检(SLNB)的可行性及手术效果。方法分析笔者所在医院2009年1月至2012年3月期间行乳腺癌SLNB病例,其中腔镜下活检107例,开放活检303例,采用放射性核素+亚甲蓝联合法与单用亚甲蓝法进行前哨淋巴结(SLN)探测。结果开放组SLN检出率联合法为94.56%(139/147),亚甲蓝法为88.46%(138/156);腔镜组联合法为94.25%(82/87),亚甲蓝法为85.00%(17/20)。检出前哨淋巴结数量,开放组联合法平均1.90枚/例,亚甲蓝法平均1.98枚/例;腔镜组则分别为1.91枚/例和1.82枚/例。SLN阳性率联合法及亚甲蓝法开放组分别为22.30%(31/139)和25.36%(35/138);腔镜组分别为19.51%(16/82)和23.53%(4/17)。上述各指标2组间的差异均无统计学意义(P>0.05)。术后并发症:腔镜组发生皮下积液的比例(5/107)高于开放组(0/303),P=0.001;其他并发症发生情况2组间比较差异均无统计学意义(P>0.05)。结论腔镜下SLNB与传统SLNB可达到相似的安全性与临床效果,但前者表现出较优越的美容效果,腔镜下SLNB可作为乳腺癌SLNB手术技术进行推广应用。     

不同示踪法在胃癌前哨淋巴结检测中的应用比较

目的 探讨理想的胃癌前哨淋巴结(SLN)检测方法.方法 前瞻性分析2004年1月至2008年8月广州军区广州总医院确诊的59例胃癌患者的临床资料,按随机数字表法将患者分为染料法组(20例)、核素法组(20例)和联合法组(19例),分别或联合注射专利蓝和99Tcm进行SLN检测.采用t检验和x2检验分析SLM的检出情况及SLN判断胃癌区域淋巴结转移的准确率和假阴性率.结果 染料法组共检出SLN 38枚,平均1.9枚/例;核素法组共检出SLN 31枚,平均1.6枚/例;联合法组共检出SLN56枚,平均2.9枚/例.联合法组中同时被染料和核素标记的SLN为46枚,单独被染料和核素标记的SLN分别为6枚和4枚.3组SLN检测数目比较,差异有统计学意义(t=4.35,P<0.05).其中联合法组SLN的检出数目明显多于染料法组和核素法组(t=4.21,3.54,P<0.05).染料法组、核素法组和联合法组诊断胃癌淋巴结转移的准确率和假阴性率分别为95%(19/20)和5%(1/20)、90%(18/20)和10%(2/20)、100%(19/19)和0,其中联合法组的准确率最高(x2=163.01,P<0.05),假阴性率最低(x2=170.14,P<0.05).结论 联合染料和核素标记物示踪法是检测胃癌SLN的理想方法.     

乳腺癌前哨淋巴结解剖学定位的临床研究

目的:探讨示踪剂注射部位对乳腺癌前哨淋巴结(sentinel lymph node,SLN)定位的影响。方法:对53例cN0期乳腺癌患者行核素示踪联合染料染色示踪法检测SLN,在原发肿瘤表面的皮下组织内或切除活组织检查残腔肿瘤周围两点注射99m锝(99mTc)标记的硫胶体,将卡纳琳或亚甲蓝分别注射于肿瘤对角线相应部位的皮下组织内(30例)或乳头乳晕下皮下组织内(23例)。SLN活组织检查后再行腋窝淋巴结清除术,标本行常规HE染色组织学检查。结果:53例患者均成功检测出SLN,核素示踪法与蓝染料法的成功率均为96.23%(51/53),联合检测的成功率100%(53/53),共检出SLN103枚,平均每例检出1.94枚,其中50例SLN位于胸大肌外侧缘的外侧组淋巴结(LevelⅠ),1例位于胸小肌后(LevelⅡ),1例同时位于LevelⅠ及LevelⅡ,1例同时位于LevelⅠ及胸骨旁。全部病例蓝染料与核素示踪标识的SLN均为同一枚(或同一组)淋巴结,两者完全吻合;且蓝染料注射于乳头乳晕或肿瘤对角线部位与核素注射于肿瘤周围所标识的SLN也完全一致。结论:SLN可能是乳房整个器官的SLN,而非乳房某个具体部位的SLN,与示踪剂的注射部位无关。     

CEUS联合染料法在乳腺癌前哨淋巴结活检术中的应用

目的探讨CEUS联合染料法在乳腺癌前哨淋巴结活检术(SLNB)中的应用价值。方法将110例女性乳腺癌患者随机分为两组:试验组,57例接受CEUS联合染料法活检前哨淋巴结(SLN);对照组,53例接受染料法联合核素法活检SLN。两组患者均接受腋窝淋巴结清扫术(ALND)及乳腺癌根治术。依据病理结果计算并比较两种方法对SLN的检出能力。结果试验组SLN检出率[91.23%(52/57)]及每例患者SLN平均数量[(1.58±0.89)个]与对照组[100%(53/53),(1.94±0.77)个]比较,差异有统计学意义(P均0.05)。两组敏感度、准确率、阴性预测值的差异均无统计学意义[试验组:81.82%(18/22)、92.31%(48/52)、88.24%(30/34);对照组:71.43%(15/21)、88.68%(47/53)、84.21%(32/38);P均0.05];特异度及阳性预测值均为100%(30/30,32/32)。结论 CEUS联合染料法用于乳腺癌SLN活检具有一定价值。     

应用亚甲蓝行乳腺癌前哨淋巴结活检276例分析

目的 探讨以亚甲蓝作为示踪剂行乳腺癌前哨淋巴结(SLN)活检的临床应用及影响因素.方法 分析了276例临床T1-T2 N0-M0乳腺癌患者前哨淋巴结活检(SLNB)结果,对SLN检出率及假阴性率影响因素进行了初步分析.结果 276例患者中,成功检出SLN者246例(检出率为89.1%).共检出SLN 423枚,每例1～4枚.前哨淋巴结对腋窝淋巴结转移情况预测的敏感性为77.3%(68/88),假阴性率为8.1%(20/246),假阳性率为0,准确率为91.9%(226/246).临床T2N0M0SLNB成功率高于临床T1N0M0乳腺癌患者(P=0.046);年龄<50岁者SLNB检出成功率高于年龄≥50岁病例(P=0.000),SLNB假阴性率年龄<50岁者显著低于高龄患者(P=0.037);外上象限和外下象限肿瘤SLNB检出成功率明显高于其他象限(P=0.000).内上象限肿瘤SLNB假阴性率高于外上及外下象限(P=0.018).临床TMN分期、EB、PR表达情况及病理类型对SLNB成功率及假阴性率无影响.结论 以亚甲蓝作为示踪剂行乳腺癌SLNB,患者年龄、临床TNM分期、肿瘤部位对SLN检出率有一定影响,患者年龄、肿瘤部位可影响SLNB假阴性率.     

新型前哨淋巴结活检技术在选择性腋窝淋巴结清扫中的应用

目的 采用经前哨淋巴通道(SLC)行前哨淋巴结活检(SLNB)新技术,判断腋窝淋巴结状态及指导选择性腋窝淋巴结清扫(ALND).方法 采用非随机对照研究,通过前哨淋巴通道行SLNB.根据前哨淋巴结(SLN)的术中病理结果行选择性ALND的患者为A组,其中SLN为阳性,行ALND为A1组,SLN为阴性,仅行SLNB为A2组;无论SLN状态,SLNB后均行ALND的患者为B组.结果 2008年7月至2009年6月共114例早期乳腺癌患者行SLNB,检出i12例,A1组28例,A2组25例,B组59例.联合法和染料法检出率为分别为98.1%(102/104)和100.0%(10/10),两者差异无统计学意义(P>0.05).假阴性率为2.30%(2/87),假阳性率为0.89%(1/112).检出SLN1～4枚,共146枚,平均1.3枚.ALND组(A1+B)并发症发生率(52.9%)高于SLNB组(A2)并发症发生率(4.0%)(x~2=15.9675,P相似文献   

吲哚菁绿荧光导航技术在乳腺癌前哨淋巴结活检中的应用

目的:评价吲哚菁绿(ICG)荧光技术应用于乳腺癌前哨淋巴结活检(SLNB)的可行性。方法:选择2010年11月—2012年2月期间68例乳腺癌患者,其中36例以ICG荧光导航技术进行SLNB(ICG组),32例应用美蓝为示踪剂行SLNB(染料组)。所有患者SLNB结束后行I、II水平腋窝淋巴清扫。结果:两组基本临床资料差异无统计学意义(均P0.05),具有可比性。ICG组前哨淋巴结(SLN)检出率为97.2%(35/36),染料组为81.3%(26/32),前者明显高于后者(P0.05)。假阴性率与每例患者平均检测SLN数量两组间差异无统计学意义(均P0.05)。结论:用ICG荧光导航技术行乳腺癌SLNB,其检出率高于染料法,且同时具备核素、染料示踪剂的替代选择。     

前哨淋巴结检测在乳腺癌治疗中的意义

目的评价前哨淋巴结活检术 (sentinellymphnodebiopsy,SLNB)预测腋淋巴结肿瘤转移的准确性及其临床意义。方法使用专利蓝染色法和 /或99mTc标记的硫胶体示踪法对我院收治的81例乳腺癌患者进行前哨淋巴结活检。两种方法联合检测 3例前哨淋巴结 (sentinellymphnode ,SLN)均阴性者未行腋淋巴结清扫术。结果 81例患者SLN总检出率为 96 3% (78/81) ,总准确率为97 5 % ,总假阴性率 9 7%。 5 3例单纯染色法检出率为 92 5 % ,准确率 94 2 % ,假阴性率 15 8% ;2 8例99mTc示踪法和 /或染色法联合检测结果分别为 10 0 % ,10 0 %和 0。结论SLNB能够准确预测腋窝淋巴结的转移状况。两种方法联合检测为最佳。术前化疗对假阴性率可能有影响。     

前哨淋巴结活检在乳腺癌中的临床应用

目的 探讨术中前哨淋巴结（sentinel lymph node,SLN）定位和活检（SLNB）对预测乳腺癌腋窝淋巴结（axillary lymph node,ALN）转移的准确性.方法 对48例乳腺癌患者术前10min用亚甲蓝注射液4ml注射到肿瘤周围或活检腔的正常乳腺组织,进行SLN定位和活检,然后行乳腺癌改良根治术.结果 SLNB的检出成功率为95.8%,准确率为97.8%,假阴性率3.0%,假阳性率为0.结论 用亚甲蓝作SLN定位进行SLNB能准确预测乳腺癌ALN转移状态.     

Evolution of sentinel lymph node biopsy for melanoma at a National Cancer Institute-designated cancer center

BACKGROUND: Sentinel lymph node biopsy (SLNB) has rapidly evolved into the standard of care for clinically node-negative melanoma. Since adopting sentinel lymph node (SLN) technology in 1993, we have periodically reviewed our institution's results and made several modifications. METHODS: From January 1993 to December 1998, 182 patients with clinically node-negative primary cutaneous melanoma underwent SLNB. Charts were retrospectively reviewed and assessed for the technique for the identification of the SLN, the pathologic analysis, and the use of intraoperative frozen section. RESULTS: The accuracy of SLN identification improved from 91% to 100% with the combination of isosulfan blue dye and radiolabeled colloid over isosulfan blue dye alone. Routine versus selective lymphoscintigraphy identified 7 in-transit SLNs and increased detection of dual nodal basin drainage (15%-27%). Identification of micrometastases in the SLN increased from 14% to 24% after a modification of pathologic evaluation. The positive SLN was the only involved node in most patients (80%). Intraoperative frozen section had a sensitivity of 58% and was of benefit in only 13 of 124 patients (10%). CONCLUSIONS: Several modifications to the identification of the SLNs and the detection of metastatic melanoma have improved our outcome with SLNB. A careful, periodic review of results to identify areas for improvement at each institution is crucial to the success of SLNB for melanoma.     

Methylene Blue Dye as an Alternative to Isosulfan Blue Dye for Sentinel Lymph Node Localization

Background: Our study describes the use of methylene blue dye as an alternative to isosulfan blue dye to identify the sentinel lymph node (SLN).Methods: A retrospective analysis was performed of 112 breast cancer patients (113 axillae) who underwent SLN biopsy (SLNB) with methylene blue dye and ^99mTc-labeled sulfur colloid for SLN identification. All SLNs were submitted for intraoperative frozen section analysis, hematoxylin and eosin stain, and immunohistochemical evaluation. Patients with a pathologically negative SLN did not undergo further axillary lymph node dissection.Results: Of 112 patients who underwent SLNB, the SLN was identified in 107 (95.5%); 104 (92.8%) were identified by methylene blue dye. In a subset of 99 patients with recorded isotope status in relation to blue nodes, concordant identification with both dye and isotope was observed in 94 (94.9%). Of patients with identified SLNs, 32 (29.9%) of 107 contained metastatic disease, with 31 (96.9%) of 32 identified by methylene blue dye. The SLN was the only positive node in 18 (60.0%) of 30 patients.Conclusions: SLNB with methylene blue dye is an effective alternative to isosulfan blue dye for accurately identifying SLNs in breast cancer patients.Presented at the Society of Surgical Oncologys 55th Annual Cancer Symposium, Denver, Colorado, March 14–17, 2002.     

Evaluation of the benefit of using blue dye in addition to radioisotope for sentinel lymph node biopsy in patients with breast cancer

The techniques for performing sentinel lymph node biopsy (SLNB) vary from institution to institution. Some advocate blue dye only, others radioisotope only, and many utilize a combination of both. The purpose of this study is to evaluate the additional benefit that blue dye provides when used in combination with a radioisotope. From October 2001 to June 2004, 102 SLNBs were attempted in 99 patients with breast cancer using a combination of blue dye and radioisotope. A lymph node was considered a sentinel lymph node (SLN) when it was stained with blue dye, had a blue lymphatic afferent, or had increased radioactivity. Ninety-eight patients had 101 successful identifications of SLNs, for an identification rate of 99%. Twenty-eight patients had positive SLNs. In three of those patients, although there were SLNs identified by both techniques, the positive SLNs were identified with only blue dye. Of the 102 SLNB procedures, there were two patients whose only SLN was identified by blue dye only. Although blue dye did not improve the identification rate, there was a definite benefit in improving the false-negative rate.     

Decreased Identification Rate of Sentinel Lymph Node after Neoadjuvant Chemotherapy

We prospectively studied the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy by comparing the identification rate and the false-negative rate (FNR) with the results obtained from the patients without chemotherapy. From October 2001 to March 2003, a total of 284 consecutive patients who underwent SLNB and axillary lymph node dissection (ALND) at the Center for Breast Cancer, National Cancer Center were enrolled. Of the 284 patients, 54 underwent neoadjuvant chemotherapy prior to operation. The sentinel lymph node (SLN) was mapped by radioactive colloid alone or in combination with blue dye. All SLNs were evaluated by 2 mm serial sections after hematoxylin-eosin staining. The overall SLN identification rate was 91.9% (261/284): 72.2% (39/54) of the patients after chemotherapy and 96.5% (222/230) of the patients without chemotherapy. These results suggest that preoperative chemotherapy significantly affects lymphatic mapping (p< 0.001). Among the patients with chemotherapy, there were 3 false negatives in 39 successfully mapped tumors, yielding an FNR of 11.1% (3/27), a negative prediction value (NPV) of 80.0% (12/15), and an accuracy of 92.3% (36/39). There were 10 false negatives among 222 successfully detected patients without chemotherapy, yielding an FNR of 9.9% (10/101), an NPV of 92.4% (121/131), and an accuracy of 95.5% (212/222). These results were not statistically different when compared (p > 0.05). Although the SLN identification rate significantly decreased after neoadjuvant chemotherapy, SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.     

Reoperative sentinel lymph node biopsy in patients with locally recurrent breast cancer

BACKGROUND: Sentinel lymph node biopsy (SLNB) is considered a standard of care in the staging of breast cancer. The objective was to examine our experience with reoperative SLNB. METHODS: We identified 19 patients in our breast cancer database who had a SLNB in the reoperative setting. All 19 patients had undergone previous breast-conserving surgery with either an axillary lymph node dissection or an SLNB. The reoperative sentinel lymph node (SLN) was identified using blue dye, radioisotope, or both. RESULTS: The SLN was identified in 84% of the reoperative cases. Of these successful cases, both blue dye and radioisotope were used in five cases, and radioisotope alone was used in 11 cases. Radioisotope identified the SLN in the 100% of successful SLNB cases (P = .0003). There were 3 unsuccessful cases in which blue dye and radioisotope failed to identify the sentinel node. CONCLUSIONS: Reoperative SLNB after previous axillary surgery is technically feasible.     

Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate

BACKGROUND:

Numerous studies have demonstrated that sentinel lymph node (SLN) biopsy can accurately determine axillary nodal status for breast cancer, but unacceptably high false negative rates have also been reported. Attention has been focused on factors associated with improved accuracy. We have previously shown that injection of blue dye in combination with radioactive colloid reduces the false negative rate compared with injection of blue dye alone. We hypothesized that this may be from the increased ability to identify multiple sentinel nodes. The purpose of this analysis was to determine whether removal of multiple SLNs results in a lower false negative rate.

STUDY DESIGN:

The University of Louisville Breast Cancer Sentinel Lymph Node Study is a prospective multiinstitutional study. Patients with clinical stage T1-2, N0 breast cancer were eligible for enrollment. All patients underwent SLN biopsy using blue dye alone, radioactive colloid alone, or both agents in combination, followed by completion level I and II axillary dissection.

RESULTS:

A total of 1,436 patients were enrolled in the study from August 1997 to February 2000. SLNs were identified in 1,287 patients (90%), with an overall false negative rate of 8.3%. A single SLN was removed in 537 patients. Multiple SLNs were removed in 750 patients. The false negative rates were 14.3% and 4.3% for patients with a single sentinel node versus multiple sentinel nodes removed, respectively (p = 0.0004, chi-square). Logistic regression analysis revealed that use of blue dye injection alone was the only factor independently associated with identification of a single SLN (p < 0.0001), and patient age, tumor size, tumor location, surgeon’s previous experience, and type of operation were not significant.

CONCLUSIONS:

The ability to identify multiple sentinel nodes, when they exist, improves the diagnostic accuracy of SLN biopsy. Injection of radioactive colloid in combination with blue dye improves the ability to identify multiple sentinel nodes compared with the use of blue dye alone.     

A Randomized Study Comparing the Effectiveness of Methylene Blue Dye with Lymphazurin Blue Dye in Sentinel Lymph Node Biopsy for the Treatment of Cutaneous Melanoma

Background  Radioactive colloid with a gamma probe is the most effective method of identifying sentinel lymph nodes (SLN). Nevertheless, since vital blue dyes are also helpful for visually identifying SLN during surgical dissection, they are often used together with radioactive colloid. There has occasionally been a shortage of lymphazurin blue (LB) dye for use in sentinel lymph node biopsies (SLNB). There have also been reports of anaphylactic reactions to the use of LB dye. Therefore, we were interested in using methylene (MB) blue dye to aid in the visualization of the SLN for biopsy because of its ready availability and greater safety. The purpose of this study of SLN biopsies was to compare the effectiveness of MB with that of LB dye. Study Design  We randomly assigned 159 consecutive patients with intermediate and high-risk melanomas, who were treated by a single surgeon at the Yale Melanoma Unit between January 10, 2005, and June 13, 2007 with SLN biopsy, with radioactive colloid and either LB or MB. Results  A total of 443 SLN were identified and removed from these 159 consecutive patients. MB dye was found to be as effective as LB dye in visually identifying SLN: blue dye was visible in 62% of SLN in the MB group compared with 58% in the LB group. When the SLN were separated into three anatomic locations the visualization results were LB 36% and MB 72% (P = 0.010) for head and neck, LB 65% and MB 61% (P = 0.919) for axilla, and LB 59% and MB 67% (P = 0.001) for groin. Conclusion  SLN were identified in all 158 patients. Approximately 60% of these SLN were also visibly blue. In the cervical and groin regions, MB dye was more visible in the SLN than was the LB dye, and in the axilla the SLN were equally stained blue by both dyes. Generally, if surgeons wish to use intradermal injections of vital blue dye to help visualize SLN, we have found in this study that MB is at least as effective as LB for the visualization of these SLN. The cost of MB is less than that of LB.     

Meta-analysis of sentinel lymph node biopsy in breast cancer.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a minimally invasive way to diagnose axillary lymph node (ALN) metastases in breast cancer. The most important features are ability to identify the SLN (I.D. rate), how often the SLN and ALN pathology match (concordance), and how often the SLN is negative for cancer when the ALNs are positive (false negative). Technique and patient criteria for SLNB vary among studies. This study performed meta-analysis of published studies to determine the I.D., concordance, and false negative rate (1) overall and for (2) both blue dye and radiocolloid, (3) the injection method, (3) palpable and nonpalpable ALNs, and (4) invasive and in situ disease. METHODS: Inclusion criteria were patients with breast cancer who had SLNB followed by ALN dissection with H&E staining. Meta-analysis was performed using analysis of variance with each observation weighted inversely to its variance. P < 0.05 was considered significant. RESULTS: Eleven studies (n = 912) met the inclusion criteria. Overall, 762 (84%) SLNs were identified, concordance was 747/762 (98%), and 15/296 (5%) were falsely negative. Highest I.D. rates (P < 0.05) were reported with albumin radiocolloid or dye + radiocolloid (97 and 94%, respectively), with injection around an intact tumor (96%), with invasive cancer (95%), and in the clinically negative axilla (96%). Concordance and false negative rates did not vary. CONCLUSIONS: The SLN can be identified in over 97% of patients if certain techniques and inclusion criteria are used. SLNB reflects the status of the axilla in 97% of cases and has a 5% false negative rate.