| 1、Research of Breast Lymphatic Pathways and securitywith Indocyanine Green Fluorescence Imaging in Patients with Breast CancerMethods: This study enrolled a total of 154 primary breast cancer patients who need to receive breast modified radical surgery or sentinel lymph node biopsy in Breast Disease Center of Southwest Hospital from May 2015 to December 2015.Indocyanine green was injected intradermally in the areola5 min before operation,to observe whether subcutaneouslymphatic channels were immediately visible.Then the preliminary classification of fluorescent lymph drainage pathways was performed.Results:The fluorescent lymphatic pathways were successfullyvisualized in 144patients(93.5% 144/154).One fluorescent lymphatic pathway wasvisualized in 47.2% of patients(68/144);two pathways in 42.4%(61/144);three fluorescent pathways in 10.4%(15/144).We classified three types of lymphatic pathway.TypeⅠ: in 129(89.6%)patients,1-3 lymphatic vessels,originated from the areola separately,eventually joined together and only one pathway was directed to theaxillary region as one vessel.Type Ⅱ: in 3 patients(9.0%),2 lymphatic vessels,originated from the areola separately,went into axillary region,with no convergence or intersection;Type Ⅲ: in 2 patients(1.4%),3 lymphatic vessels,originated from the areola separately,went into axillary region,with no convergence or intersection.Conclusion:In most of patients,1-2 lymphatic vessels originating from the areola separately converge into axillary region as one vessel.The fluorescence lymphatic imaging is a simple,safe and effective way to visualize lymph nodes,with SLN detection rate noninferior to RI or methylene blue.It has the potential as a new tracer for sentinel lymph node biopsy,however,large-scale clinical research is necessary.2、Sensitivity of indocyanine green for sentinel lymph node biopsy in breast cancerMethods: Twenty breast cancer patients with clinically node negative in Breast Disease Center of Southwest Hospital from May 2015 to July 2015 received sentinel lymph node biopsy using methylene blue,radioisotope and indocyanine green as tracers.The detection rate of sentinel lymph nodes and the sensitivity of 3 methods were compared.Results:In 20 patients,a total of 106 lymph nodes were detected: 96 lymph nodes were detected by indocyanine green,(4.8±2.78)per patient,37 by methylene blue,median 1(1-3.5),58 by radioisotope,(2.9±2.51)per patients.The detection rate was 80.00%(16/20)by methylene blue,100.00%(20/20)by radioisotope,(20/20)by indocyanine green respectively.No adverse reaction and complications occurred in sentinel lymph node biopsy.Conclusion: comparing with methylene blue and radioisotope,indocyanine green has the former similar sensitivityto identify sentinel lymph node in detection number of SLN and metastatic SLNin SLNB.With advantages of simple operation and high visibility,indocyanine green is considered as an alternative to radioisotope,worthy of clinical application.3、Application of indocyanine green combined with methylene blue for sentinel lymph node biopsy in early breast cancerMethods: Totally 104 breast cancer patients with clinically node negative in Breast Disease Center of Southwest Hospital from May 2015 to December 2015 were randomly divided into two groups by the random number table method for a prospective study.The experimental group underwent sentinel lymph node biopsy using indocyanine green combined with methylene blue,control group using radioisotope combined with methylene blue.The detection rate of SLN was compared between two groups.Results:In experimental group,subcutaneous lymphatic vessels were visualized in 49(94.2% 49/52)patients and fluorescent SLNs were detected in 52 patients(100%),SLN detection rate was 100%(52/52),higher than 96.2%(50/52)in control group.In experimental group,190 SLNs were detected,median 3(2-4);in control group,158 SLNs were detected,median 2(1-4);the difference was not significant(Z=-1.58,P=0.113).The detection rate of metastatic SLNs was 32.7%(17/52)in experimental group,15.4%(8/52)in control group,indicating a significant difference(X2=4.27,P=0.039).In the ICG combined with MB group,26(13.8% 26/190)metastatic SLNs were detected in experimental group,significantly higher than 9(5.7%)in control group(Z= -2.15,P=0.032).Conclusion: In sentinel lymph node biopsy of breast cancer patients,indocyanine green combined with methylene blue has SLN detection rate non-inferior to radioisotope combined with methylene blue.It can increase the detection rate of metastatic SLNs,precisely localize SLNs and reduce operation difficulty,worthy of clinical application. |
PDF Full Text Request