Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer
Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer
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DOI：
10.1016/j.breast.2010.01.014
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发表时间：
2010-06-01
期刊：
影响因子：
3.9
通讯作者：
Kinoshita, Takayuki
中科院分区：
文献类型：
--
作者：
Hojo, Takashi;Nagao, Tomoya;Kinoshita, Takayuki
背景资料：保守性乳腺切除术和随后的前哨淋巴结活检（SNB）是一种越来越受欢迎的初始方法，用于治疗乳腺癌，由于降低了侵袭性。SNB是一种较短的手术，副作用比更实质性的外科手术少，但有时无法识别转移性疾病。因此，需要一种高灵敏度和方便的方法来识别SNB中具有高含病概率的前哨淋巴结（SLN）。我们比较了放射性同位素或染料与荧光化合物的组合，以分析淋巴流量，以确定SNB.Materials和方法的目标：我们研究了乳腺癌患者的腋窝淋巴结（ALN）缺乏转移。开发了两种靶向SNB的方法：（1）在手术前将吲哚菁绿色（ICG）和专利蓝注射到覆盖肿瘤和乳晕下区域的皮肤中。(2)将ICG和放射性胶体注射到覆盖肿瘤和乳晕下区域的皮肤中。使用光动力眼（PDE）观察引流荧光淋巴管。我们去除了通过染料和荧光成像方法鉴定的SLN。方法Ⅰ组113例，方法Ⅱ组29例。在我们的研究中，患者根据淋巴流分为两种类型：C型表现为会聚到一个淋巴管。结果：荧光显像法检出前哨淋巴结99.3%，平均每例患者检出3.8个。专利蓝染料和放射性胶体的SLN识别率分别为92.9%和100%，而每例患者分别用这些方法看到1.9和2.0个SLN。我们根据淋巴引流的模式将淋巴流分为两种类型。C型向单个淋巴管汇集，而S型向单独的淋巴管引流。S型引流29/142例（20.4%），C型引流113/141例（79.6%）。在S型引流的患者中，每例患者有4.1个SLN，但在C型引流的个体中，每例患者仅观察到3.4个SLN。40例ALNs中发现转移，其中5例为染色阴性和荧光阳性。在这些情况下，SLN确定的平均数是一个。结论：荧光与可见染料的组合是一个高度敏感的方法SLN的识别。当SNB仅通过染料方法指导时，S型淋巴引流或弱染料染色的患者有丢失适当SLN的风险。在这些情况下，荧光方法与染料一起使用可以增加检测的灵敏度。此外，荧光方法对于不能使用常规放射性测量的医院来说是理想的。(C)2010爱思唯尔有限公司版权所有。
Background: Conservative breast resection with subsequent sentinel lymph node biopsy (SNB) is an increasingly popular initial approach for the treatment of breast cancer due to decreased invasiveness. SNB is a shorter procedure with fewer side effects than more substantial surgical procedures, but it sometimes fails to identify metastatic disease. Therefore, a highly sensitive and convenient method is needed to identify sentinel lymph nodes (SLN) with a high probability of containing disease in SNB. We compared the combination of radioisotope or dye with a fluorescence compound to analyze lymph flow to identify targets for SNB.Materials and methods: We examined patients with breast cancer lacking metastases in the axillary lymph node (ALN). Two methods for targeted SNB were developed: (1) Indocyanine Green (ICG) and Patent blue were injected into the skin overlying the tumor and sub-areolar region just before the surgical procedure. (2) ICG and radiocolloid were injected into the skin overlying the tumor and subareolar region. The draining fluorescent lymphatic duct was visualized using a Photodynamic Eye (PDE). We removed the SLNs that were identified by the dye and fluorescence imaging methods. Method I was applied to 113 patients undergoing SNB, and 29 patients were treated with Method 2. In our study, patients were grouped by lymph flow into two types: Type C demonstrated convergence to one lymph duct. Type S demonstrated separate lymph ducts.Results: Using the fluorescence imaging method, 99.3% of SLNs were identified, and 3.8 SLNs per patient were seen. The SLN identification rates for Patent blue dye and radiocolloid were 92.9% and 100%, respectively, while 1.9 and 2.0 SLNs per patient, respectively, were seen with these methods. We classified two types of lymph flow based on the pattern of lymphatic drainage. Type C converged to a single lymph duct, while Type S drained to separate ducts. Type S lymph drainage was seen in 29/142 patients (20.4%), and Type C drainage was found in 113/141 patients (79.6%). Of the patients with Type S drainage, there were 4.1 SLNs per patient, but only 3.4 SLNs per patient were seen in individuals with Type C drainage. Forty cases had metastases found in the ALNs, and five of these cases were dye-negative and fluorescence-positive. Among these cases, the average number of SLNs identified was one.Conclusion: The combination of fluorescence with a visible dye is a highly sensitive method for SLN identification. When SNB is guided by only the dye method, there is a risk of missing appropriate SLNs in patients with Type S lymph drainage or weak dye staining. The use of a fluorescence method together with dye could increase sensitivity of detection in these cases. Furthermore, fluorescent methods are ideal for hospitals that cannot use conventional radioactive measures. (C) 2010 Elsevier Ltd. All rights reserved.