Indocyanine green combined with methylene blue for sentinel lymph node biopsy in breast cancer patients

doi:10.3877/cma.j.issn.1674-0807.2016.02.005

Abstract

Abstract:

Objective

To evaluate the application value of indocyanine green (ICG) combined with methylene blue (MB) for sentinel lymph node biopsy(SLNB) in breast cancer patients.

Methods

Totally 104 breast cancer patients with axillary node negative indicated by preoperative examination in Department of Breast Surgery, Southwest Hospital, Third Military Medical University, from May 2015 to December 2015 were enrolled for a prospective study. They were randomly divided into two groups (n=52) by the random number table method: experimental group with MB combined with ICG as lymph tracer, control group with nuclide combined with MB as lymph tracer for SLNB. During operation, the surgeon decided whether to perform axillary lymph node dissection according to the result of intraoperative frozen section examination. The detection rates in SLNB were compared between two groups. Skewed distribution data were described as M(P₂₅-P₇₅).χ² test and Fisher's exact probability test or non-parametric test were used to compare the number of detected sentinel lymph nodes (SLNs) and metastatic SLNs,and the detection rates of the two in two groups.

Results

In 52 patients of experimental group, subcutaneous lymphatic vesselsc were visualized in 49 patients(94.2%,49/52) and SLNs were visualized in 52 (100%). The detection rate of SLNs was 100% (52/52) in experimental group, 96.2% (50/52) in control group. The detection rate of metastatic SLNs was 32.7%(17/52) in experimental group, significantly higher than 15.4% (8/52) in control group (χ²= 4.27, P=0.039). Totally 190 SLNs [median 3(2-4)] were detected in experimental group,158 [median 2 (1-4)]in control group, indicating no significant difference (Z=-1.58,P=0.113). Twenty-six metastatic SLNs[median 0 (0-1)] were detected in experimental group,Nine[median 0 (0-0)] in control group, indicating significant difference (Z=-2.15,P=0.032).

Conclusion

Compared with nuclide plus methylene blue,indocyanine green combined with methylene blue for intraoperative SLNB in breast cancer patients has similar detection rate of SLNs and higher detection rate of metastatic SLNs, with the advantages of precise positioning of SLNs, reducing the difficulty of operation, worthy of clinical application.

Key words: Breast neoplasms, Sentinel lymph node biopsy, Indocyanine green

Long Yuan, Yan Zhou, Ying Hu, Hongyi Wei, Qinwen Pan, Kongyong Zhang, Jun Jiang. Indocyanine green combined with methylene blue for sentinel lymph node biopsy in breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2016, 10(02): 87-91.

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Figures/Tables 4

References 15

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组别	例数	年龄		绝经状态		体质指数			肿瘤大小		肿瘤部位
组别	例数	≤50岁	＞50岁	绝经前	绝经后	18.5～23.9	24.0～27.9	≥28.0	T₁	T₂	左乳	右乳
对照组	52	31	21	30	22	29	20	3	27	25	22	30
试验组	52	33	19	36	16	29	20	3	24	28	21	31
检验值		χ²=0.16		χ²=1.49		Z=0.00			χ²=0.35		χ²=0.04
P值		0.687		0.222		1.000			0.556		0.842
组别	例数	肿瘤分布的象限					病理类型				临床分期		新辅助化疗
组别	例数	外上	外下	内上	内下	乳头乳晕区	浸润性导管癌	浸润性小叶癌	原位癌	其他	Ⅰ	Ⅱ	有	无
对照组	52	22	10	14	2	4	41	0	7	4	27	25	20	32
试验组	52	33	7	6	3	3	43	0	5	4	24	28	16	36
检验值		χ²=6.27					χ²=0.46				χ²=0.35		χ²=0.68
P值		0.180					0.931				0.556		0.410

组别	例数	年龄		绝经状态		体质指数			肿瘤大小		肿瘤部位
组别	例数	≤50岁	＞50岁	绝经前	绝经后	18.5～23.9	24.0～27.9	≥28.0	T₁	T₂	左乳	右乳
对照组	52	31	21	30	22	29	20	3	27	25	22	30
试验组	52	33	19	36	16	29	20	3	24	28	21	31
检验值		χ²=0.16		χ²=1.49		Z=0.00			χ²=0.35		χ²=0.04
P值		0.687		0.222		1.000			0.556		0.842
组别	例数	肿瘤分布的象限					病理类型				临床分期		新辅助化疗
组别	例数	外上	外下	内上	内下	乳头乳晕区	浸润性导管癌	浸润性小叶癌	原位癌	其他	Ⅰ	Ⅱ	有	无
对照组	52	22	10	14	2	4	41	0	7	4	27	25	20	32
试验组	52	33	7	6	3	3	43	0	5	4	24	28	16	36
检验值		χ²=6.27					χ²=0.46				χ²=0.35		χ²=0.68
P值		0.180					0.931				0.556		0.410

亚甲蓝	吲哚菁绿		合计
亚甲蓝	检出	未检出	合计
检出	44	0	44
未检出	8	0	8
合计	52	0	52

亚甲蓝	吲哚菁绿		合计
亚甲蓝	检出	未检出	合计
检出	44	0	44
未检出	8	0	8
合计	52	0	52

亚甲蓝	吲哚菁绿		合计
亚甲蓝	转移	未转移	合计

转移	11	0	11
未转移	6	35	41
合计	17	35	52

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