吲哚菁绿荧光导航技术联合纳米炭在早期乳腺癌前哨 淋巴结活检中的应用价值

目的 探讨吲哚菁绿（ICG）导航技术联合纳米炭混悬液（CNP）在早期乳腺癌前哨淋巴结活检（SLNB）中的 应用价值和优势。方法 回顾性分析 2013 年 6 月—2016 年 4 月在中山大学附属佛山医院行 SLNB 的 294 例腋窝 淋巴结阴性的早期乳腺癌患者的资料，其中采用 ICG 联合 CNP 示踪 149 例（联合组），美蓝示踪 145 例（美蓝组）。前 哨淋巴结（SLNs）未转移者免除腋窝清扫术（ALND），转移者即刻行 ALND。比较 2 组患者中 SLNs 的检出率、检出数 目及转移性 SLNs 的检出情况，分析年龄及体质量指数（BMI）对 SLNs 检出率的影响。结果 联合组皮肤淋巴管显影 率为 97.3%（145/149），淋巴结显影率为 95.9％（143/149）。联合组的 SLNs 检出率高于对照组（97.9% vs. 91.0%，χ2= 6.902，P＜0.05）。联合组 SLNs 平均检出数量多于美蓝组［（4.5±1.6）枚 vs. （3.2±1.5）枚，t=4.476，P＜0.05］。联合组共 检出 SLNs 715 枚，其中转移淋巴结 58 枚（8.1%），美蓝组共检出 544 枚，其中转移淋巴结 26 枚（4.7%），联合组转移 性 SLNs 检出率高于美蓝组（χ2=13.714，P＜0.01）。年龄、BMI 并不影响 2 组 SLNs 的检出率和转移检出率。结论 吲哚菁绿荧光导航技术联合纳米炭实施乳腺癌前哨淋巴结活检的稳定性和可操作性较强，检出率高，可作为实施 SLNB 的新方法。

Clinical value of indocyanine green fluorescence navigation combined with carbon nanoparticles in sentinel lymph node biopsy for patients with early breast cancer

Objective To explore the clinical value of indocyanine green (ICG) fluorescence navigation combined with carbon nanoparticles (CNP) in sentinel lymph node biopsy (SLNB) for patients with early breast cancer. Methods A total of 294 early breast cancer patients with axillary node negative in Department of Breast Surgery, Foshan Hospital Affiliated to Sun Yat-Sen University from June 2013 to April 2016 were retrospectively analyzed. Of the patients, 149 cases underwent SLNB with ICG combined with CNP (combination group), while 145 cases underwent SLNB with methylene blue alone (MB group). If the intraoperative pathology results of sentinel lymph nodes (SLNs) were negative, axillary lymph node dissection (ALND) was avoided. The SLNs detection rate, detection number, metastatic SLNs detection rate in SLNB were compared between two groups. The influence of age and body mass index (BMI) on SLNs detection rate was also analyzed. Results In the combination group, subcutaneous lymphatic channels were successfully visualized in 145 patients, and the detection rate was 97.3% (145/149). The fluorescence of SLNs was successfully detected in 143 patients, and the detection rate was 95.9% (143/149). The detection rate of SLNs was higher in the combination group than that of methylene dye alone group (97.9% vs. 91.0%，χ2=6.902，P＜0.05). The average number of detected SLNs was higher in the combination group than that of methylene dye alone group (4.5±1.6 vs. 3.2±1.5，t=4.476，P＜0.05). Fifty-eight metastatic SLNs were found in 715 SLNs in the combination group (8.1%), and 26 in 544 SLNs in MB group (4.7%). The detection rate was significantly higher in the combination group than that of methylene dye alone group (χ2=13.714，P＜0.01). Age and BMI showed no influence on the detection rate and accuracy of SLNB in two groups (P > 0.05). Conclusion The combined tracing of ICG fluorescence and carbon nanoparticles for SLNB has showed a better stability and operability in patients with early breast cancer, which is recommended to be a new SLNB method.