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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。
Objective To investigate the value of fluorescence method in sentinel lymph node biopsy (SLNB) in patients with breast cancer. Methods Thirty-six patients with breast cancer who were admitted to MCH from May 2014 to February 2015 were prospectively collected. Indocyanine green (ICG) fluorescent tracer was injected intradermally and subcutaneously into the areola, Locating the sentinel lymph nodes (SLNs) dynamically guided positioning, the tracing effect of ICG and the predicting effect of SLNB on axillary lymph node metastasis were analyzed. Results The success rate of SLNB and SLN in all 36 cases was 100%. There were 86 SLNs (1 ~ 3 cases / case, average 2.39 cases / case). The operation time from skin incision to SLN removal was 3 ~ 22 min, an average of 9 min. Intraoperative frozen pathological examination showed 16 cases of SLN cancer metastasis, 20 cases of SLN cancer metastasis; 1 case intraoperative frozen pathological examination showed no SLN cancer metastasis, postoperative paraffin section pathological examination showed SLN cancer metastasis. The sensitivity of SLNB was 94.1% (16/17) and the false negative rate was 5.9% (1/17) with ICG tracing. Conclusion The dynamic localization of SLNB for breast cancer with fluorophore method has the advantages of accurate localization, high detection rate and small trauma. It can accurately predict the status of axillary lymph nodes in breast cancer patients.