The Clinical Value Of Indocyanine Green And Methylene Blue In Sentinel Lymph Node Biopsy For Breast Cancer

BackgroundAs peoples research to the biological characteristics of breast cancer,breast cancer surgery gradually narrows down.As a way of minimally invasive surgery of breast cancer,sentinel lymph node biopsy(SLNB)widely has been applied to our clinical.SLNB not only keeps the similar therapeutic effect with axillary lymph node dissection(ALND),but also reduces the postoperative complications and improves the life quality of patients.Currently,SLNB tracer method has the dye method,the radioactive isotope method and the combination method,different tracer methods directly affect the success rate,accuracy and false negative rate of SLNB,indirectly affect the prognosis of patients.Guidelines recommend application of the combination method,however,these reasons,such as the complex operation,the expensive equipment,the radioactive risk;limit its application in primary hospitals in China.The most common tracer method of the dye method at our country is methylene blue.In recent years,fluorescent agent indocyanine green as a new type of tracer start to be applied in SLNB for breast cancer and have a better detection effect.Making the use of its characteristics under the near-infrared fluorescence system,it has obvious advantages compared with methylene blue,but the detection effects of indocyanine green and methylene blue need further verification.ObjectiveTo discuss the clinical application value of the combination method by the combination of indocyanine green and methylene blue versus methylene blue alone in sentinel lymph node biopsy for breast cancer.MethodsSelected the patients with early breast cancer,who received SLNB in Department of Head and Neck Breast Surgery,the Central Hospital of Xinxiang City from January 2015 to August 2016,they were randomized the combination group(46 patients with the method of indocyanine green and methylene blue)and the methylene blue group(74 patients with the methylene blue method).Indocyanine green was by intradermal injection in areola area,methylene blue was by subcutaneous injection in areola area.The combination group guided by near-infrared fluorescence imaging systems and along the blue dye lymphatic detected sentinel lymph nodes,methylene blue group along the blue dye lymphatic detected sentinel lymph nodes,all of the removed sentinel lymph nodes were quickly frozen biopsy and routine pathological examination,every patient underwent ALND after SLNB.ResultsThe detection rate,accuracy,sensitivity,specificity,the false-negative rate,the average number of SLN in the combination group respectively was 97.8%(45/46),95.6%(43/45),94.1%(16/17),96.4%(27/28)and 5.9%(1/17),3.1±0.9,in the methylene blue group,they respectively was 86.5%(64/74),90.6%(58/64),87.5%(21/24),92.5%(37/40),12.5%(3/24),2.1 ± 0.7,the detection rate,the accuracy,sensitivity,specificity,the average number of SLN in the combination group were higher than the methylene blue group,the false negative rate of the former was lower than the latter,the differences of the detection rate,the average number of SLN between the two groups were statistically significant(P < 0.05),but differences of the accuracy,sensitivity,specificity and the false-negative rate between the two groups has no statistical significance(P>0.05).Conclusion1.In this study,indocyanine green was in the application of SLNB for breast cancer and could intuitively show the lymphatic drainage direction under the guidance of near-infrared fluorescence navigation system,accurately locate position of the sentinel lymph node,lower the blindness of SLNB,reduce the damage to the tissue.2.In this study,by comparing indocyanine green and methylene blue with methylene blue alone,indocyanine green and methylene blue in the SLNB for early breast cancer can improve the detection rate and the average number of SLN.It is a very promising SLNB tracer method.