| ObjectiveWith the development of breast screening technology and increased awareness of female breast examination,the detection rate of nonpalpable breast lesions(NPBL)has increased significantly.The precise resection of NPBL depends largely on the preoperative localization technology.Although carbon dyes(carbon nanoparticle suspension)and blue dyes(methylene blue)are widely used in sentinel lymph node biopsy in breast cancer,their application value in NPBL remains to be discussed.Therefore,this study aims to evaluate the clinical value of carbon nanoparticle and methylene blue localization in precise resection of NPBL.MethodThis clinical trial included 105 female NPBL patients(a total of 172 lesions)admitted to xx Hospital from April 2018 to January 2020.All patients were confirmed to have nonpalpable lesions by breast ultrasound and underwent surgery.The cases were randomly divided into carbon nanoparticle suspension localization group and methylene blue localization group.Before surgery,each lesion needed to be localized under ultrasound and marked on body surface.The size and depth of tumor were measured at the same time.Under the guidance of ultrasound,the carbon nanoparticle or methylene blue was injected at 3 points along the track "lesion's surface-lesion's vertical gland intermediate position-gland surface".The injection time of the two groups was randomly divided into 2 hours,4 hours,6 hours,12 hours,16 hours and 20 hours.The participants were scheduled to undergo breast lumpectomy if the intraoperative frozen diagnosis was benign,or modified radical mastectomy if it was malignant.All removed specimens were sent for pathological examination.The total resection volume(TRV)was calculated from the three dimensions measured during surgery.At the same time,record the staining dates intraoperation.The optimal resection volume(ORV)was calculated based on three dimensions measured by the final pathology.ResultStaining was present in all cases in carbon nanoparticle group(109/109,100%),while only 53 of the 63 cases in the methylene blue group were present(53/63,84.1%).The difference was statistically significant(P<0.001).There was significant correlation between staining time and staining area in methylene blue group(r=-0.767,P<0.001).There was no significant correlation in carbon nanoparticle group(r=-0.154,P=0.110).The resection time was 11.05±3.40min in carbon nanoparticle group,13.48±6.22min in the methylene blue group(P<0.001).However,the resection time of 53 staining existing cases in methylene blue group(11.91±4.34min)was not significantly different from the carbon nanoparticle group.The TRV of the carbon nanoparticle group was 2.51±2.42cm3,which was lower than that of the methylene blue group(3.69±3.24 cm3),and the difference was statistically significant(P=0.016).As for the calculated resection ratio(CRR,CRR=ORV/TRV),carbon nanoparticle group(7.62±0.49)was lower than the methylene blue group(21.93±78.00),which was statistically significant(P=0.018).During the follow-up(2 to 18 months),the NPBL recurred in 9 patients(14.5%)in carbon nanoparticle group,while 8 patients in the methylene blue group(18.6%)(P=0.537).No significant differences were found in appearance and scar.There is no dye remained on the skin in the methylene blue group.However,dye remains in 12 patients in carbon nanoparticle group(19.4%),and the difference was statistically significant(P=0.001).ConclusionCarbon nanoparticle suspension and methylene blue are safe and feasible for localizing NPBL.The staining time showed a negative correlation with staining area and intensity in methylene blue group.Localization and operation should be performed within 6 hours before operation.The correlation in carbon nanoparticle groups is not statistically significant.The carbon nanoparticle suspension remains within 5 days.The carbon nanoparticle group has lower TRV and CRR,which can more effectively avoid excessive resection of normal tissue. |
PDF Full Text Request