Clinical Analysis Of ICG Combined With MB In Sentinel Lymph Node Biopsy Of Breast Cancer

Objective:To investigate the clinical value of indocyanine green(ICG)combined with methylene blue(MB)in sentinel lymph node biopsy(SLNB)of breast cancer.Methods:A total of 120 breast cancer patients with T1～2N0M0 were selected from July 2017 to December 2019 in this area and confirmed by preoperative puncture biopsy pathology or intraoperative mass resection followed by freezing pathology.All patients underwent SLNB.Patients were divided into three groups according to the use of different tracers:MB group;Carbon nanoparticle suspensions(CNS)group(CNS group);ICG combined with MB group,40 cases in each group.All SLN were examined by intraoperative frozen pathology and routine paraffin pathology.Axillary lymph node dissection(ALND)or only low level ALND can be performed in patients with intraoperative freezing pathology suggesting no cancer metastasis in SLN.If SLN appears cancer metastasis,ALND is performed routinely.If intraoperative frozen pathology indicated no cancer metastasis in SLN and postoperative routine paraffin section indicated cancer metastasis in SLN,ALND should be supplemented.Detailed medical records and pathological data were collected,and the number of SLN detection,SLN detection rate,SLN positive rate and tracking time of the three groups were recorded according to the pathological results of conventional paraffin sections after SLN operation,and statistical analysis was conducted.Results:No adverse reactions related to the tracer agent occurred in any of the three groups.1.MB group:30 of 40 patients successfully detected SLN,with a detection rate of 75%(30/40);105 lymph nodes were obtained,with an average of 2.63±1.81 lymph nodes,11 of which had metastasis,with a positive rate of 10.5%(11/105);the tracking time was 25-40 minutes,with an average time of 31.6±4.89 minutes.In CNS group,38 of 40 patients successfully detected SLN,the detection rate was 95%(38/40);148 lymph nodes were obtained,with an average of 3.70±1.42 lymph nodes,33 of which had metastasis,and the positive rate of SLN was 22.30%(33/148);the tracking time was 20-40 minutes,with an average of 28.9 ± 4.64 minutes.In ICG combined with MB group,SLN was successfully detected in 39 of 40 patients,with a detection rate of 97.5%(39/40);165 lymph nodes were obtained,with an average detection rate of 4.13 ± 1.20 lymph nodes,41 of which had metastasis,and the positive rate of SLN was 22.85%(41/165);the tracking time was 15-35 minutes,with an average time of 21.83 ± 6.63 minutes.2.Comparison of detection rates of each group:the SLN detection rates of ICG combined with MB group were higher than those of MB group,and the difference was statistically significant(P<0.05).The SLN detection rate of ICG combined with MB group was higher than that of CNS group,and the difference was not statistically significant(P>0.05).The detection rate of SLN in CNS group was higher than that in MB group,and the difference was statistically significant(P<0.05).Comparison of positive rate of each group:SLN positive rate of ICG combined with MB group was higher than that of MB group,and the difference was statistically significant(P<0.05).The SLN positive rate of CNS group was higher than that of MB group,and the difference was statistically significant(P<0.05).The SLN positive rate of ICG combined with MB group was higher than that of CNS group,and the difference was not statistically significant(P<0.05).Comparison of average number of detection in each group:SLN detection in ICG combined with MB group was higher than that in MB group,and the difference was statistically significant(P<0.05).The number of SLN detection in ICG combined with MB group was higher than that in CNS group,and the difference was not statistically significant(P>0.05).The number of SLN detection in CNS group was higher than that in MB group,and the difference was statistically significant(P<0.05).Comparison of tracer time in each group:the tracer time in ICG combined with MB group was shorter than that in MB group and CNS group,and the difference was statistically significant(P<0.05).The tracer time of CNS group was shorter than that of MB group,and the difference was statistically significant(P<0.05).Conclusion:1.ICG combined with MB tracer SLN can obtain higher SLN detection rate,SLN positive rate,SLN detection number and shorter tracer time,and the operation is simple and the learning curve is short.ICG combined with MB tracer can be given priority.2.MB,CNS and ICG can all be used to trace SLN.In the absence of ICG,CNS can be given priority,and MB can be used in primary hospitals with limited conditions.