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首页> 中文期刊> 《中国全科医学》 >染料示踪法联合荧光示踪法提高乳腺癌前哨淋巴结活检术成功率

染料示踪法联合荧光示踪法提高乳腺癌前哨淋巴结活检术成功率

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摘要

背景近年来乳腺癌前哨淋巴结活检术（SLNB）愈来愈受到重视，而示踪剂的选择对于其成功率至关重要。目的评价染料示踪法联合荧光示踪法在乳腺癌 SLNB 中的临床有效性以及应用价值。方法选取2010年1月—2015年9月同济大学附属杨浦医院乳腺外科符合纳入标准的原发性浸润性乳腺癌患者449例为研究对象。采用随机数字表法将患者分成 A 组（226例，采用染料示踪法）和 B 组（223例，采用染料示踪法联合荧光示踪法）。收集患者一般资料〔包括年龄、体质指数（BMI）〕，计算各组患者 SLNB 成功率。将患者以 BMI（≤22.5 kg/ m2和﹥22.5 kg/m2）、年龄（≤55岁和﹥55岁）进行分层分析。结果 A 组患者年龄、BMI 小于 B 组（P ﹤0.05）。223例 BMI≤22.5 kg/ m2患者中，采用染料示踪法联合荧光示踪法 SLNB 成功率〔94.7％（108/114）〕高于采用染料示踪法〔78.0％（85/109）〕〔OR ＝5.082，95％ CI（1.988，12.993）〕。226例 BMI ﹥22.5 kg/ m2患者中，采用染料示踪法联合荧光示踪法 SLNB 成功率〔85.3％（93/109）〕高于采用染料示踪法〔63.2％（74/117）〕〔 OR ＝3.378，95％ CI（1.763，6.471）〕。不同 BMI 层之间同质（χ2BD ＝0.495，P ＝0.482）。去除 BMI 的混杂作用后，采用染料示踪法联合荧光示踪法SLNB 成功率高于采用染料示踪法（χ2MH ＝25.979，P ﹤0.001，ORMH ＝3.896）。244例≤55岁患者中，采用染料示踪法联合荧光示踪法 SLNB 成功率〔92.6％（112/121）〕高于采用染料示踪法〔75.4％（94/123）〕〔OR ＝3.928，95％ CI （1.731，8.515）〕。205例﹥55岁患者中，采用染料示踪法联合荧光示踪法 SLNB 成功率〔87.3％（89/102）〕高于采用染料示踪法〔63.1％（65/103）〕〔OR ＝4.002，95％ CI（1.975，8.111）〕。不同年龄层之间同质（χ2BD ＝0.006，P＝0.939）。去除年龄的混杂作用后，采用染料示踪法联合荧光示踪法 SLNB 成功率高于采用染料示踪法（χ2MH＝26.686，P ﹤0.001，ORMH ＝3.928）。Logistic 回归分析结果显示，示踪法、BMI、年龄是 SLNB 结果的影响因素（P﹤0.05）。Logistic 回归模型分类预测准确率为80.2％。结论染料示踪法联合荧光示踪法可有效提高乳腺癌 SLNB 成功率，值得临床推荐使用。%Background The sentinel lymph node biopsy(SLNB)of breast cancer is gaining increased attention in recent years,and the choosing of tracer is of great importance in its success rate. Objective To evaluate the clinical effectiveness and application value of the combined tracer method of fluorescence and dye in SLNB of breast cancer. Methods According to the inclusion criteria of the study,449 patients with primarily invasive breast cancer,who received treatment in Department of Breast Surgery of Yangpu Hospital,Tongji University from January 2010 to September 2015,were selected as research objects. Patients were divided into group A(226 patients with dye tracer method)and group B(223 patients with the combined tracer method of fluorescence and dye)by random number table method. The general information〔 including age,body mass index(BMI)〕of patients were collected,the success rate of patients' SLNB were calculated. Stratified analysis of patients were made based on their BMI(≤22. 5 kg/ m2 and ﹥ 22. 5 kg/ m2 )and age(≤55 and ﹥ 55). Results BMI and age in group A were less than those in group B(P ﹤ 0. 05). Among the 223 patients(BMI≤22. 5 kg/ m2 ),the success rate of SLNB with combined tracer method of fluorescence and dye〔94. 7%(108 / 114)〕was higher than that of SLNB with dye tracer method〔78. 0%(85 / 109)〕〔OR = 5. 082,95% CI(1. 988,12. 993)〕. Among the 226 patients(BMI ﹥ 22. 5 kg/ m2 ),the success rate of SLNB with combined tracer method of fluorescence and dye〔85. 3%(93 / 109)〕was higher than that of SLNB with dye tracer method〔63. 2%(74 / 117)〕 〔 OR = 3. 378,95% CI(1. 763,6. 471)〕. Two subgroups with different BMI were homogeneous( χ2BD = 0. 495,P = 0. 482). After removing the confounding effects of BMI,the success rate of SLNB with combined tracer method of fluorescence and dye was higher than that of SLNB with dye tracer method( χ2MH = 25. 979,P ﹤0. 001,ORMH = 3. 896). Among the 244 patients( age ≤55),the success rate of SLNB with combined tracer method of fluorescence and dye〔92. 6%(112 / 121)〕was higher than that of SLNB with dye tracer method〔75. 4%(94 / 123)〕〔OR= 3. 928,95% CI(1. 731,8. 515)〕. Among the 205 patients( age ﹥ 55),the success rate of SLNB with combined tracer method of fluorescence and dye〔87. 3%(89 / 102)〕was higher than that of SLNB with dye tracer method〔63. 1%(65 / 103)〕〔OR = 4. 002,95% CI(1. 975,8. 111)〕. Two subgroups with different ages were homogeneous(χ2BD = 0. 006,P = 0. 939). After removing the confounding effects of age,the success rate of SLNB with combined tracer method of fluorescence and dye was higher than that of SLNB with dye tracer method(χ2MH = 26. 686,P ﹤ 0. 001,ORMH = 3. 928). The Logistic regression analysis showed that the tracer method,BMI and age were the influencing factors of SLNB results(P ﹤ 0. 05). The predicted accurate rate of Logistic model was 80. 2% . Conclusion Combined tracer method of fluorescence and dye can effectively improve the success rate of SLNB of breast cancer,which worth to be recommended in clinic.

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  • 来源
    《中国全科医学》 |2016年第24期|2900-29032914|共5页
  • 作者

    崔嵘嵘; 林晓燕; 许诚; 胡贇宏; 王铮元; 蔡丰丰;

  • 作者单位

    200090 上海市;

    同济大学附属杨浦医院乳腺外科;

    同济大学医学院全科医学系;

    200090 上海市;

    同济大学附属杨浦医院乳腺外科;

    同济大学医学院全科医学系;

    200090 上海市;

    同济大学附属杨浦医院乳腺外科;

    同济大学医学院全科医学系;

    200090 上海市;

    同济大学附属杨浦医院乳腺外科;

    同济大学医学院全科医学系;

    200090 上海市;

    同济大学附属杨浦医院乳腺外科;

    同济大学医学院全科医学系;

    200090 上海市;

    同济大学附属杨浦医院乳腺外科;

    同济大学医学院全科医学系;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 乳腺肿瘤;
  • 关键词

    乳腺肿瘤; 前哨淋巴结活检; 染料示踪法; 荧光示踪法; 吲哚菁绿; 示踪剂;

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