| Objective To explore the advantages and disadvantages of preoperative and intraoperative radionuclide imaging combined with methylene blue tracing in sentinel lymph node biopsy for breast cancer,and to optimize the sentinel lymph node biopsyMethods A total of 89 female breast cancer patients diagnosed and treated by Department of Oncology,Second Affiliated Hospital of Fujian Medical University from January 2015 to May 2017 were retrospective analysed.According to the different methods of sentinel lymph node biopsy,they were divided into two groups: combined group(58 cases)and methylene blue group(31cases).For combined group,using 99 m TC-sulfur colloid as a tracer,preoperative lymphography guided by SPECT/CT firstly applicated,and the sentinel lymph node was detected by gamma ray detector combined with methylene blue staining;For methylene blue group,the methylene blue was used single to detect the sentinel lymph node.The difference of detection rate,accuracy rate,false negative rate,number of detection,And operation time between the two groups were analyzed to evaluate the clinical value of preoperative and intraoperative radionuclide imaging combined with methylene blue staining.Results There were no significant differences in age,BMI,menstrual status,tumor size,tumor location,pathological type and surface receptor between the combination group and the methylene blue group(P>0.05).The detection rate of the combined group was 98.27%(57/58),the detection rate of the methylene blue group was 83.87%(26/31),and the detection rate of the combined group was higher than that of the methylene blue group,the difference was statistically significant(P<0.05);The average number of sentinel lymph nodes in the combined group was 4.14±0.95,and the average number of lymph nodes in the methylene blue group was 3.03±0.72,The average number of sentinel lymph nodes in the combined group was higher than that of in the methylene blue group,The difference was statistically significant(P<0.05).The false negative rate and accuracy rate of the combined group were 0.00%(0/21)and 100%(57/57)respectively,the false negative rate and accuracy rate of the methylene blue group were 9.09%(1/11)and 96.15% (25/26)respectively,the false negative rate and accuracy rate were no significant difference between the two groups(P>0.05);The average operation time of the sentinel lymph node biopsy in the combined group was 20.03±4.00 min,the average operation time of the sentinel lymph node biopsy in the methylene blue group was 20.03±4.00 min,the operation time of sentinel lymph node biopsy in the combined group was lower than that of in the methylene blue group,and the difference was statistically significant(P<0.05).There were 47 successful cases of preoperative lymphatic imaging guided by SPECT/CT in the combined group,so the positive rate of preoperative lymphatic imaging was 81.03%(47/58).According to the result of preoperative lymphatic imaging,the combined group was divided into two subgroups: 1.positive subgroup(n=47),2.negative subgroup(n=11).There were no significant differences in age,BMI,menstrual status,tumor size,tumor location,pathological type and surface receptor between the positive subgroup and the negative subgroup(P>0.05).The detection rate of the positive subgroup was 100%(47/47),the detection rate of the negative subgroup was 90.90%(10/11).,the difference was not statistically significant(P>0.05).The false negative rate of positive subgroup was 0.00%(0/17),the accuracy rate of positive subgroup was 100%(47/47),the false negative rate of negative subgroup was 0.00%(0/4),and the accuracy rate of negative subgroup was 100%(10/10),there was no difference in the false negative rate and accuracy rate between the positive subgroup and the negative subgroup.The average number of sentinel lymph nodes in the positive subgroup was 4.17±0.93,and the average number of lymph nodes in the negative subgroup was 4.00±1.05,The difference was not statistically significant(P>0.05).The average operation time of sentinel lymph node biopsyin the positive subgroup was 18.68±2.47 min,the average operation time of sentinel lymph node biopsy in the negative subgroup was 25.79±4.24 min,and the average operation time of sentinel lymph node biopsy in the methylene blue group was 28.86±4.76 min,the average operation time of sentinel lymph node biopsy in the positive subgroup was lower than that in the negative subgroup and the methylene blue group,and the difference was statistically significant(P<0.05),but the difference between the negative subgroup and the methylene blue group was not statistically significant(P>0.05).Conclusion Compared to the single use of methylene blue,preoperative lymphography guided by SPECT/CT combined with intraoperative nuclide and methylene blue staining can improve the detection rate and number of sentinel lymph node biopsy in breast cancer.The positive results of preoperative lymphatic imaging have no significant effect on the detection rate and number of sentinel lymph nodes,but it can help to reduce the operation time of sentinel lymph node biopsy and facilitate the discovery of non-axillary sentinel lymph nodes.Preoperative and intraoperative radionuclide imaging combined with methylene blue is a safe and effective method to find breast cancer sentinel lymph nodes,which is worthy of clinical application. |
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