新型荧光示踪剂在乳腺癌前哨淋巴结活检术中的应用研究

doi:10.19401/j.cnki.1007-3639.2020.03.003

中国癌症杂志 ›› 2020, Vol. 30 ›› Issue (3): 174-178.doi: 10.19401/j.cnki.1007-3639.2020.03.003

新型荧光示踪剂在乳腺癌前哨淋巴结活检术中的应用研究

吴　爽 ^1,2,3 ，孙　晓 ^2,3 ，丛斌斌^2,3 ，毕　钊 ^1,2,3 ，周鹏鹏 ^1,2,3 ，石志强 ^2,3 ，王永胜 ^2,3

1. 济南大学山东省医学科学院医学与生命科学学院，山东济南 250200；
2. 山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心，山东济南 250117；
3. 山东第一医科大学（山东省医学科学院），山东济南 250062

出版日期:2020-03-30 发布日期:2020-04-03
通信作者: 王永胜 E-mail: wangysh2008@aliyun.com

A novel fluorescent tracer for sentinel lymph node biopsy in breast cancer

WU Shuang ^1,2,3 , SUN Xiao ^2,3 , CONG Binbin ^2,3 , BI Zhao ^1,2,3 , ZHOU Pengpeng ^1,2,3 , SHI Zhiqiang ^2,3 , WANG Yongsheng ^2,3

1. School of Medicine and Life Sciences, University of Jinan and Shandong Academy of Medical Sciences, Jinan 250200, Shandong Province, China; 2. Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan 250117, Shandong Province, China; 3. Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250062, Shandong Province, China

Published:2020-03-30 Online:2020-04-03
Contact: WANG Yongsheng E-mail: wangysh2008@aliyun.com

摘要/Abstract

摘要： 背景与目的：吲哚菁绿（indocyanine green，ICG）与利妥昔单抗（rituximab，Rit）偶联可使ICG在淋巴结显像中具有靶向性。探讨ICG-Rit用于乳腺癌前哨淋巴结活检（sentinel lymph node biopsy，SLNB）的可行性。方法：入组山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心96例原发性乳腺癌患者（100例次SLNB）。ICG与Rit质量比为93.75 μg∶375.00 μg。术前行ICG-Rit、联合示踪剂（亚甲蓝及核素示踪剂）乳房注射，联合法行SLNB，对检出淋巴结进行荧光显像检测，记录荧光显像淋巴结及灰度值，分析ICG-Rit淋巴结显像情况并评价对比联合法的一致性。观察患者过敏反应并检测术后嗜酸性粒细胞计数。结果：ICG-Rit病例显像率为97.0%（97/100）。ICG-Rit显像前哨淋巴结（sentinel lymph node，SLN）的均数为2.44，中位数为2；低于核素法检出SLN的均数（2.80）和中位数（3）。ICG-Rit对比联合法SLNB的准确率为97.0%（97/100），灵敏度为96.2%（25/26），假阴性率为3.8%（1/26），kappa值为0.973（P＜0.001）。显像淋巴结灰度值最高254，显像淋巴结灰度值集中在220~254，＜220者术中荧光不易察觉，缺乏连续性。入组患者术前未见过敏反应，术后嗜酸性粒细胞计数未增高。结论：ICG-Rit能够减少对非SLN（non-SLN，n-SLN）的显像。对比联合法，准确率和符合率高，安全性良好。

关键词: 乳腺癌, 前哨淋巴结活检术, 吲哚菁绿-利妥昔单抗

Abstract: Background and purpose: Indocyanine green (ICG) combined with rituximab (Rit) produces a new receptor-targeted tracer (ICG-Rit). This study aimed to investigate the feasibility of ICG-Rit as a fluorescent tracer for sentinel lymph node biopsy (SLNB) of breast cancer. Methods: A total of 96 patients with primary breast cancer were included in the Breast Cancer Center, Shandong Cancer Hospital and Institute. The mass ratio of the preparation reagent was 93.75 μg of ICG∶375.00 μg of Rit. ICG-Rit and combined tracer (methylene blue and isotope) were injected into the breast before operation. SLNB was performed by the combined method, lymph nodes were detected by fluorescence imaging, and gray-scale values were recorded. We analyzed the lymph node imaging of ICG-Rit and evaluated the consistency of the combined ICG-Rit method. We observed patient’s allergic reaction and detected postoperative eosinophil count. Results: The imaging rate of ICG-Rit was 97.0% (97/100). The mean and median of sentinel lymph node (SLN) in ICG-Rit imaging were 2.44 and 2, which were lower than those detected by isotope (2.80 and 3), respectively. Compared with the combined method, the accuracy of ICG-Rit SLNB was 97.0% (97/100), the sensitivity was 96.2% (25/26), the false negative rate was 3.8% (1/26), and the kappa value was 0.973 (P<0.001). The highest gray value of lymph nodes was 254, which was concentrated in 220-254. It was difficult to detect fluorescence in patients with gray value ＜220 and lacked continuity. The patients who were enrolled did not have an allergic reaction before operation, and the postoperative eosinophil count did not increase. Conclusion: ICG-Rit, as a fluorescent tracer, can reduce the imaging of non-SLN (n-SLN). Compared with the combined method, the accuracy and coincidence rate are high, and the safety is good.

Key words: Breast cancer, Sentinel lymph node biopsy, Indocyanine green-rituximab

吴　爽 , 孙　晓 , 丛斌斌 , 毕　钊 , 周鹏鹏 , 石志强 , 王永胜 . 新型荧光示踪剂在乳腺癌前哨淋巴结活检术中的应用研究[J]. 中国癌症杂志, 2020, 30(3): 174-178.

WU Shuang , SUN Xiao , CONG Binbin , BI Zhao , ZHOU Pengpeng , SHI Zhiqiang , WANG Yongsheng . A novel fluorescent tracer for sentinel lymph node biopsy in breast cancer[J]. China Oncology, 2020, 30(3): 174-178.

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新型荧光示踪剂在乳腺癌前哨淋巴结活检术中的应用研究

A novel fluorescent tracer for sentinel lymph node biopsy in breast cancer

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