Patterns of clinical practice for sentinel lymph node biopsy in women with node-negative breast cancer: the results of a national survey in Japan
Patterns of clinical practice for sentinel lymph node biopsy in women with node-negative breast cancer: the results of a national survey in Japan
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DOI：
10.1007/s12282-016-0720-5
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发表时间：
2017-03-01
期刊：
影响因子：
4
通讯作者：
Toi, Masakazu
中科院分区：
文献类型：
--
作者：
Ikeda, Takafumi;Sugie, Tomoharu;Toi, Masakazu
前哨淋巴结（SLN）活检现已被接受为淋巴结阴性乳腺癌女性腋窝分期的标准治疗方法。目前，可用的示踪剂有染料、放射性同位素 (RI) 和荧光吲哚菁绿 (fICG)。这三种示踪剂对于 SLN 活检的重要性已得到认可，但 SLN 定位的趋势尚未报道。这项全国性调查的目的是评估日本 SLN 活检的实践模式。这项调查旨在检查一名或多名日本乳腺癌协会 (JBCS) 委员会认证的外科医生从事乳腺癌护理的中心的 SLN 活检临床实践。他们的答复于 2014 年 10 月 1 日至 30 日期间记录，并通过邮件或传真在日本收到。调查问卷包括三项内容：每年接受治疗的乳腺癌患者人数、单年进行前哨淋巴结活检的次数以及前哨淋巴结检测的方法。排除63个不进行手术的中心，总共对412份答复进行了分析。其中，206 个 (50%) 中心拥有伽马探针，118 个 (29%) 中心拥有近红外荧光成像系统，49 个中心 (12%) 均配备这两种系统。 137 (33%) 中 RI 和 fICG 均不可用。染色法优先用于私立医院。在 412 个中心，每年共有 36,221 名患者接受前哨淋巴结活检，其中 23,038 名患者 (64%) 接受放射性示踪剂治疗。 fICG 与 RI 联合应用的患者分别为 83% 和 13%。仅 4% 的患者使用了单独 RI 的单次标测。非放射性方法用于 13,183 名 (36%) 患者的常规 SLN 活检 [8533 名 (24%) 患者仅使用染料，4650 名 (12%) 患者仅使用 fICG]。 64% 的早期乳腺癌女性使用放射性示踪剂进行 SLN 活检，而约 24% 的患者仅接受染料，这在 PH 中尤其普遍。 fICG 作为非放射性方法仅在 12% 中使用，但国家健康保险计划对 fICG 的激励计划可以增加 NIR 成像系统的数量并提高日本 SLN 活检的灵敏度。
Sentinel lymph node (SLN) biopsy is now accepted as the standard of care for axillary staging in women with node-negative breast cancer. Currently, dye, radioisotope (RI), and fluorescence indocyanine green (fICG) are tracers available. Importance of these three tracers has been recognized for SLN biopsy but the trend for SLN mapping has not been reported. Aim of this national wide survey was to evaluate practice patterns of SLN biopsy in Japan.This survey was conducted to examine the clinical practice of SLN biopsy in centers where one or more Japanese Breast Cancer Society (JBCS) board-certified surgeons practice breast cancer care. Their responses were recorded from 1 to 30 Oct 2014 and received by mail or fax in Japan. The questionnaire included three items: the number of breast cancer patients treated per year, the number of SLN biopsy procedures in a single year, and the methods for SLN detection.A total of 412 responses excluding the 63 centers that do not perform the surgery were analyzed. Out of them, 206 (50 %) centers had a gamma probe, 118 (29 %) had an NIR fluorescence imaging system, and both were available at 49 (12 %) of the centers. Neither RI nor fICG was available in 137 (33 %). The dye method was preferentially used in private hospitals. In 412 centers, a total of 36,221 patients underwent SLN biopsy per year and 23,038 (64 %) received radioactive tracer. fICG was co-applied with RI in 83 and 13 % of patients, respectively. Single mapping with RI alone was used in only 4 % of patients. The non-radioactive method was used for routine SLN biopsy in 13,183 (36 %) patients [8533 (24 %) for dye alone and 4650 (12 %) for fICG alone].A radioactive tracer was used in 64 % of women with early breast cancer for SLN biopsy while approximately 24 % received dye alone, which was especially prevalent in PHs. The fICG was used in only 12 % as a non-radioactive method but incentive package for fICG by national health insurance plan could increase the number of NIR imaging systems and improve the sensitivity for SLN biopsy in Japan.