| Background:With the gradual increase in the incidence of cancer, breast cancer has become the most common cancer in women, the number of new breast cancer and the number of deaths due in breast cancer are increasing year by year, in the study of early breast cancer lymph node metastasis in 60% of the way-70% of patients without axillary lymph node metastasis, the concept of sentinel lymph node (sentinel lymph node, SLN) is gradually being raised by a large number of academics and research confirms, in breast cancer, SLN's ability to accurately predict the presence of ipsilateral axillary lymph node tumor cells transfer, so according to SLN biopsy (SL-NB) results to decide whether to ipsilateral axillary lymph node dissection (axillary lymph node dissection, ALND), such as sentinel lymph node metastasis, the ipsilateral axillary dissection, such as sentinel lymph node cancer cell transfer, you do not need line of ipsilateral axillary lymph node dissection. Which can effectively avoid underwent ALND no axillary metastasis, reduce axillary lymph node dissection after complications brought about (such as upper limb edema, sensory and motor dysfunction), to reduce the impact on the quality of life of patients, but not cleared No axillary lymph node metastasis of breast cancer metastasis is equivalent to retain the first barrier, can effectively improve the local anti-tumor immune function. The study of sentinel lymph node biopsy (Sentinel Lymph Node Biopsy, SLNB) to carry out, it will move towards minimally invasive breast surgery is an important turning point in the development process. Sentinel lymph node mapping for tracers currently used are: dye tracer isotope tracer method or magnetic, fluorescent dyes into three categories, they are still not the specific use technical methods unified standard. Currently accepted conditions sentinel lymph tracer should have the following four aspects:First, not toxic to humans; secondly tracer can be absorbed by the lymphatic vessels and lymph nodes; re able to clearly show the lymphatic vessels and lymph node tracing; finally able In the lymph vessels and lymph nodes were to stay longer. Can SLNB application in clinical practice, the key to see whether to make real the sentinel lymph node biopsy.Object:carbon nanoparticles in early breast cancer, indocyanine green tracer sentinel lymph node biopsy, by comparing the two tracers detection rate under the influence of related factors, as well as both the overall detection rate sensitivity accuracy rate, false negative rate, the average detection time compared to evaluate carbon nanoparticles and indocyanine green, two tracers in the sentinel lymph node biopsy in the presence advantage.Method:1. Select the Affiliated Hospital of Binzhou Medical College Hospital during April 2013-2014 October Breast Surgery thyroid treated 94 cases of breast cancer patients in the study, were randomly divided into two groups by occasional sampling:(a) nano-carbon group,45 cases; (b) indocyanine green group of 49 patients. Two sets of data in the patient's age, tumor stage by statistical software SPSS13.0 statistical analysis, no significant difference (P> 0.05), comparable.2, the implementation of all of the surgical procedure by the same operation group. 1) nano-carbon Group:Take 30 minutes before surgery nanometer carbon 0.5ml min 4:00 (3:00,6:00,9:00,12:00) subcutaneous injection around the areola and glandular tissue.2) indocyanine green groups:patient satisfaction with anesthesia routine disinfection shop towels, surgery to take 0.5ml sub 4:00 (3:00,6:00,9:00,12:00) subcutaneous injection around the areola, taking care to avoid the injection of indocyanine Green solution leakage, prevent pollution and affect the surgical fluorescent detection lymphatic leakage if there saline gauze dipped in net, and then confirmed by fluorescence detection.3, nano-carbon group of at least 30 minutes after the injection, the outside of the pectoralis major ipsilateral axillary fold lower edge for transverse incision the skin, subcutaneous, layer by layer dissected and stained lymphatic Looking track, on the outside edge of the chest muscle size Deep loose connective tissue found in the lymph nodes stained, that sentinel lymph node. If you look for shallow lymphatic tracer fails, the size of the muscle to the outer edge of the axillary chest deep anatomical directly looking stained lymph nodes, sentinel lymph node that is in the loose tissue. Indocyanine green was injected indocyanine green dye along a few seconds you can see 1-4 branch extended to the axillary lymphatic direction, real-time fluorescence detector probe to take shape axillary lymphatic fluoresce in tracing the lymphatic branches converge and the disappearance of the place as a transverse incision, layer by layer and find fluoresce dissected lymph nodes, sentinel lymph node that will fluoresce find sentinel lymph node dissection to send quick frozen biopsy, underwent modified radical mastectomy and postoperative surgical pathology specimens routine inspection.Result:1, nano-carbon group 45 cases detected in sentinel lymph nodes in 43 cases. The detection of sentinel lymph node 1-4 pieces. Nano Carbon Group:its sentinel lymph node detection rate 95.56%(43/45), accuracy was 91.11%(41/45) sensitivity of 88.89% before (16/18), the false negative rate 11.11%(2/18), the false positive rate is 0, the average time to detection of sentinel lymph node 17.56min.2, indocyanine green groups:49 cases detected in sentinel lymph nodes in 46 cases. The detection of sentinel lymph node 1-4 pieces. Its sentinel lymph node detection rate 93.88%(46/49), accuracy was 91.84%(45/49), sensitivity was 95.00% (19/20), the false negative rate 5.00%(1/20), the false positive rate is 0, the average time to detection of sentinel lymph node is 10.43min.3, by comparing the nano-carbon group, the evaluation of indocyanine green group, (P> 0.05), there was no statistically significant difference. However, there was a significant difference (P<0.05) between the detection time, there are statistically significant. |
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