CAJ | 학술논문

目的：探讨吲哚菁绿联合纳米碳作为淋巴示踪剂在乳腺癌前哨淋巴结活检手术中的应用价值。方法将112例临床腋窝淋巴结阴性的乳腺癌患者随机分为2组，56例接受吲哚菁绿联合纳米碳示踪，56例接受单药吲哚菁绿示踪。2组均进行前哨淋巴结活检手术，手术切除的前哨淋巴结送术中冰冻及常规石蜡和免疫组织化学病理检查。结果联合示踪组体外淋巴管显影率为94.6％（53／56），单药示踪组体外淋巴管显影率为96.4％（54／56）。联合组54例可见明显荧光浓聚，52例可见明显黑染淋巴结，2例无明显荧光浓聚患者可找到黑染淋巴结，4例未见黑染淋巴结可荧光显影，均成功检出前哨淋巴结，检出率100％（56／56）；单药示踪组检出率92.9％（52／56）（χ2＝2.3，P＞0.050）。联合示踪组共检出前哨淋巴结205枚，平均（3.7±1.5）枚；单药示踪组共检出前哨淋巴结130枚，平均（2.5±1.4）枚（t＝－3.5，P＝0.001）。联合示踪组10例淋巴结阳性，共检出阳性淋巴结17枚；单药示踪组9例淋巴结阳性共检出阳性淋巴结12枚。结论联合应用吲哚菁绿和纳米碳进行乳腺癌前哨淋巴结活检，可实现优势互补以增加前哨淋巴结检出率和检出数，降低漏诊率和假阴性率。
목적：탐토신타정록연합납미탄작위림파시종제재유선암전초림파결활검수술중적응용개치。방법장112례림상액와림파결음성적유선암환자수궤분위2조，56례접수신타정록연합납미탄시종，56례접수단약신타정록시종。2조균진행전초림파결활검수술，수술절제적전초림파결송술중빙동급상규석사화면역조직화학병리검사。결과연합시종조체외림파관현영솔위94.6％（53／56），단약시종조체외림파관현영솔위96.4％（54／56）。연합조54례가견명현형광농취，52례가견명현흑염림파결，2례무명현형광농취환자가조도흑염림파결，4례미견흑염림파결가형광현영，균성공검출전초림파결，검출솔100％（56／56）；단약시종조검출솔92.9％（52／56）（χ2＝2.3，P＞0.050）。연합시종조공검출전초림파결205매，평균（3.7±1.5）매；단약시종조공검출전초림파결130매，평균（2.5±1.4）매（t＝－3.5，P＝0.001）。연합시종조10례림파결양성，공검출양성림파결17매；단약시종조9례림파결양성공검출양성림파결12매。결론연합응용신타정록화납미탄진행유선암전초림파결활검，가실현우세호보이증가전초림파결검출솔화검출수，강저루진솔화가음성솔。
Objective To evaluate intraoperative tracing of sentinel lymph nodes ( SLNs) by fluorescence imaging combined with carbon nanoparticles .Methods 112 breast cancer patients eligible for sentinel lymph node biopsy were randomly assigned to the combination group (56 cases)receiving indocyanine green (ICG)and carbon nanoparticles as the lymphatic mapping tracers and ICG alone group (56 cases).Intraoperative frozen sec-tion was performed , followed by conventional histopathology .Results In the combination group , subcutaneous lymphatic vessels were successfully visualized in 53 patients and the detection rate was 94.6%(53/56).The flu-orescence SLNs were successfully detected in 54 patients and the detection rate was 96.4%(54/56)in ICG alone group.In the combination group , SLNs were successfully identified in 54 patients by fluorescence and 52 patients by black dyed, and the SLNs detection rate was 100%(56/56).While in the ICG alone group, the SLNs were found in 52 patients and the detection rate was 92.9%(52/56)(χ2 =2.3, P>0.050).The average number of detected SLNs was 3.7 ±1.5 ( 205/56 ) in combination group vs 2.5 ±1.4 ( 130/52 ) in ICG alone group ( t =-3.5, P=0.001).17 metastatic SLNs were found in 10 patients in the combination group vs 12 metastatic SLNs in 9 patients in ICG alone group .Conclusion Combination of ICG and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients can increase the number of SLNs detected and the detection rate , reducing the rate of misdiagnosis and false negative rate .