实用医学杂志 ›› 2023, Vol. 39 ›› Issue (11): 1444-1450.doi: 10.3969/j.issn.1006⁃5725.2023.11.021

• 医学检查与临床诊断 • 上一篇    下一篇

吲哚菁绿近红外荧光成像技术在乳腺癌保乳手术中的应用

焦伟 赵凯 汪正 陈斌 王亚兵    

  1. 皖南医学院弋矶山医院甲乳外科(安徽芜湖 241001)
  • 出版日期:2023-06-10 发布日期:2023-06-10
  • 通讯作者: 王亚兵 E⁃mail:wangeb3@wnmc.edu.cn,陈斌 E⁃mail:chenbin@yjsyy.com
  • 基金资助:
    芜湖市科技计划项目(编号:2021cg35,2021cg15)

Application of indocyanine green near ⁃ infrared fluorescence imaging in breast conserving surgery for breast cancer 

JIAO Wei,ZHAO Kai,WANG Zheng,CHEN Bin,WANG Yabing.   

  1. Department of Thyroid and Breast Surgery,Yijishan Hospital,Wannan Medical College,Wuhu 241000,China 
  • Online:2023-06-10 Published:2023-06-10
  • Contact: WANG Yabing E⁃mail:wangeb3@wnmc.edu.cn,CHEN Bin E⁃mail:chenbin@yjsyy.com

摘要:

目的 评估近红外荧光成像技术联合吲哚菁绿显影剂在乳腺癌保乳手术中的应用价值。 方法 分析 2020 年 1 月至 2022 年 4 月于皖南医学院弋矶山医院手术治疗的 155 例乳腺癌患者的临床资 料,其中 55 例使用吲哚菁绿标记并在近红外荧光成像系统指导下完成手术(荧光组),100 例常规进行保乳手术(对照组),对比两组临床特点、诊断率、切缘状况等,探讨近红外荧光成像技术在术中肿瘤定位及 判断切缘状态方面的作用。 荧光组平均肿块切除时间(13.85 ± 3.39)min,快于对照组的(18.78 ± 4.81)min(P < 0.05);荧光组首次切缘阳性率为 3.6%,明显低于对照组的 19.0%(P < 0.05)。两组患者临床 资料及病理特征差异无统计学意义(P > 0.05)。所有患者均在原发肿瘤中检测到荧光存在。肿瘤组织、 瘤周组织和正常组织的平均荧光强度分别为 229.84 ± 22.03、144.02 ± 14.12 和 108.64 ± 9.76 个任意单位 (P < 0.05)。肿瘤对瘤周组织和正常组织的荧光信号背景比值分别为1.60 ± 0.17和2.13 ± 0.25,差异有统计 学意义(P < 0.05)。近红外荧光显像技术对乳腺癌保乳手术切缘评估的敏感度和特异度分别为 86.66% 和 94.23%。荧光组与对照组患者术后乳房美容效果优良率分别为 92.8%、80.0%,差异有统计学意义(P < 0.05)。结论 术中应用近红外荧光成像技术进行肿瘤定位可有效避免健康组织过多切除,对于切缘状态 评估具有较高的敏感性、特异性,可显著降低手术切缘阳性率,缩短手术时间。近红外荧光成像技术用于乳腺癌保乳手术是安全可行的,具有重要指导价值。

关键词: 近红外荧光成像, 乳腺癌, 吲哚菁绿, 手术切缘

Abstract:

Objective To assess the value of near⁃infrared fluorescence imaging combined with indocyanine green contrast agents in breast ⁃ conserving surgery for breast cancer. Methods The clinical data on 155 patients with breast cancer who had received surgical treatment in Yijishan Hospital of Wannan Medical College from January 2020 to April 2022 were analyzed. Of those patients,55 were labeled with indocyanine green and underwent surgery under the guidance of anear⁃infrared fluorescence imaging system(fluorescence group)and 100 receivedconventional breast conserving surgery(control group). The clinical characteristics,diagnostic rate,and margin status were com⁃ pared between the two groups,and the role of near⁃infrared fluorescence imaging in intraoperative tumor localization and margin determination was explored. Results The mean resection time was(13.85 ± 3.39)min in the fluores⁃ cence group,which was faster than(18.78 ± 4.81)min in the control group(P < 0.05). The positive rate of first inci⁃ sion margin was significantly lower in the fluorescence group than in thecontrol group(3.6%vs. 19.0%,P < 0.05). Fluorescence was detectablein primary tumors in all thepatients. The average fluorescence intensity was(229.84 ± 22.03),(144.02 ± 14.12)and(108.64 ± 9.76)arbitrary units(AU)in tumor,peritumoral and normal tissues(P < 0.05). The background ratio of tumor fluorescence signal to peritumoral tissue and tonormal tissue was(1.60 ± 0.17) and(2.13 ± 0.25),respectively(P < 0.05). The sensitivity and specificity of near⁃infrared fluorescence imaging forassessing the incisionmargin were 86.66% and 94.23%,respectively. Conclusions Intraoperative application of near⁃infrared fluorescence imaging for tumor localization can effectively avoid excessive resection of normal tissues. It has high sensitivity and specificity for the evaluation of cutting edge statusand can significantly reduce the positive.rate of cutting edge and shorten the surgical duration. Near⁃infrared fluorescence imaging technology is safe and feasible in breast⁃conserving surgery for breast cancer and has important guiding value. 

Key words: near?infrared fluorescence, breast cancer, indocyanine green, surgical margin