Clinical feasibility of imaging with indocyanine green combined with methylene blue for sentinel lymph node identification in papillary thyroid microcarcinoma
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摘要: 目的 探讨吲哚菁绿联合亚甲蓝注射在甲状腺微小乳头状癌前哨淋巴结活检术中的应用。方法 将90例甲状腺微小乳头状癌(PTMC)患者随机分为A组和B组, 每组45例。A组运用吲哚菁绿联合亚甲蓝注射检测淋巴结, B组只用蓝染法, 在荧光探测仪下发光或首先蓝染的淋巴结认定为前哨淋巴结(SLNs), SLNs切除后, 统一行中央区淋巴结清扫。术后比较两组的病理及围手术期情况。结果 A组和B组平均检测出SLNs 2.93枚和2.17枚, 检测出中央区淋巴结4.51枚和3.89枚, 两组比较差异有统计学意义(P < 0.05)。两组的灵敏度、准确度、假阴性率差异无统计学意义(P>0.05), 但A组灵敏度、准确度高于B组, 假阴性率低于B组。两组患者术中出血量、喉返神经麻痹发生率、术后引流量、淋巴漏发生率差异无统计学意义(P>0.05), A组手术时间长于B组(P < 0.05), A组术后暂时性甲状旁腺功能减退少于B组(P < 0.05)。结论 在甲状腺癌SLNs活检中, 吲哚菁绿荧光法联合亚甲蓝安全可行, 对甲状旁腺功能的保护具有临床意义。Abstract: Objective To explore the value of indocyanine green (ICG) combined with methylene blue in the identification of sentinel lymph nodes (SLNs) in patients diagnosed with papillary thyroid microcarcinoma (PTMC).Methods Ninety patients were enrolled and were randomized into group A and group B with 45 patients in each group.ICG combined with methylene blue were injected into the thyroid in group A, and only methylene blue were injected into thyroid in group B.Blue-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs.After SLNs were removed, central lymph nodes (CLNs) dissection was completed in both groups.The pathological data and postoperative outcomes were compared between two groups.Results There were significantly more SLNs (2.93/2.17) and CLNs (4.51/3.89) were dissected in group A than in group B (P < 0.05).There were no significant differences in sensitivity, accuracy and the false-negative rate according the SLNs in two groups (P>0.05), but group A has higher sensitivity and accuracy rates, and lower false-negative rate.There were no significant differences in the amount of blood loss, the amount of lymphatic drainage, and incidence of hoarseness and lymphatic leakage in two groups (P>0.05).In group A, the operating time was longer, and the rate of hypoparathyroidism was lower (P < 0.05).Conclusion Sentinel lymph nodes biopsy using ICG combined with methylene blue is feasible and safe for SLNs identification in PTMC patients.It is also clinically significant for the parathyroid gland protection.
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Key words:
- thyroid neoplasms /
- sentinel lymph nodes /
- indocyanine green /
- methylene blue
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表 1 A组和B组淋巴结检出情况比较
枚 组别 SLNs CLNs A组 2.9±1.0 4.5±1.3 B组 2.2±0.9 3.9±1.4 t 3.68 2.19 P 0.01 0.03 
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表 2 A组和B组SLNs检出指标的比较
% 组别 例数 SLNs检出率 灵敏度 准确度 假阴性率 A组 45 95.6 92.9 97.7 7.1 B组 45 80.0 84.6 94.4 15.4 χ2 5.075 0.464 0.506 0.464 P 0.024 0.496 0.450 0.496
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表 3 两组患者围手术期情况
围手术期指标 A组 B组 χ2/t P 手术时间/min 131.1±25.2 120.8±22.6 2.040 0.044 术中出血量/mL 14.5±7.9 13.2±5.5 0.960 0.340 喉返神经麻痹/例 暂时 4 1 0.146 0.167 永久 0 0 引流量/mL 103.8±30.9 101.3±24.6 0.438 0.662 淋巴漏/例 2 1 0.345 0.557 暂时性甲状旁腺功能减退/例 2 9 5.070 0.024
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[1] 罗晓, 李安华. 甲状腺微小乳头状癌的管理: 现状与争议[J]. 中华医学超声杂志(电子版), 2019, 16(1): 6-10. doi: 10.3877/cma.j.issn.1672-6448.2019.01.003
[2] 马小开, 黄建康, 朱博, 等. 228例甲状腺微小乳头状癌临床特征及颈部淋巴结转移危险因素分析[J]. 中国癌症杂志, 2019, 29(8): 590-594. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ201908006.htm
[3] Kulcsar M, Canovas NS, Araujo-Neto V, et al. New method of sentinel lymph node biopsy in transoral robotic surgery for oropharyngeal squamous cell carcinoma[J]. Clinics(Sao Paulo), 2018, 73(suppl 1): e550s.
[4] Baena Fustegueras JA, González FH, Calderó SG, et al. Magnetic detection of sentinel lymph node in papillary thyroid carcinoma: The MAGIC-PAT study results[J]. Eur J Surg Oncol, 2019, 45(7): 1175-1181. doi: 10.1016/j.ejso.2019.03.017
[5] Valente SA, Al-Hilli Z, Radford DM, et al. Near Infrared Fluorescent Lymph Node Mapping with Indocyanine Green in Breast Cancer Patients: A Prospective Trial[J]. J Am Coll Surg, 2019, 228(4): 672-678. doi: 10.1016/j.jamcollsurg.2018.12.001
[6] Ladurner R, Sommerey S, Arabi NA, et al. Intraoperative near-infrared autofluorescence imaging of parathyroid glands[J]. Surg Endosc, 2017, 31(8): 3140-3145. doi: 10.1007/s00464-016-5338-3
[7] Wang TS, Sosa JA. Thyroid surgery for differentiated thyroid cancer-recent advances and future directions[J]. Nat Rev Endocrinol, 2018, 14(11): 670-683. doi: 10.1038/s41574-018-0080-7
[8] Lim H, Devesa SS, Sosa JA, et al. Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013[J]. JAMA, 2017, 317(13): 1338-1348. doi: 10.1001/jama.2017.2719
[9] Gambardella C, Patrone R, Di Capua F, et al. The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study[J]. BMC Surg, 2019, 18(Suppl 1): 110.
[10] Albers MB, Nordenström E, Wohlfahrt J, et al. Sentinel Lymph Node Biopsy in Thyroid Cancer[J]. World J Surg, 2020, 44(1): 142-147. doi: 10.1007/s00268-019-05218-1
[11] Kelemen PR, Van Herle AJ, Giuliano AE. Sentinel lymphadenectomy in thyroid malignant neoplasms[J]. Arch Surg, 1998, 133(3): 288-292. doi: 10.1001/archsurg.133.3.288
[12] Gelmini R, Campanelli M, Cabry F, et al. Role of sentinel node in differentiated thyroid cancer: a prospective study comparing patent blue injection technique, lymphoscintigraphy and the combined technique[J]. J Endocrinol Invest, 2018, 41(3): 363-370. doi: 10.1007/s40618-017-0756-1
[13] 杜国能, 肖玉根, 檀谊洪, 等. 纳米碳在分化型甲状腺癌术中前哨淋巴结活检的临床研究[J]. 包头医学院学报, 2018, 34(4): 8-9, 38. https://www.cnki.com.cn/Article/CJFDTOTAL-BTYX201804004.htm
[14] Jozaghi Y, Richardson K, Anand S, et al. Frozen section analysis and sentinel lymph node biopsy in well differentiated thyroid cancer[J]. J Otolaryngol Head Neck Surg, 2013, 42: 48. doi: 10.1186/1916-0216-42-48
[15] Rauch P, Merlin JL, Leufflen L, et al. Limited effectiveness of patent blue dye in addition to isotope scanning for identification of sentinel lymph nodes: Cross-sectional real-life study in 1024 breast cancer patients[J]. Int J Surg, 2016, 33 Pt A: 177-181.
[16] Ríos A, Rodríguez JM, Ibañez N, et al. Detection of the sentinel node using a magnetic tracer in thyroid cancer. A technical pilot study[J]. Cir Esp, 2019, 97(3): 169-174. doi: 10.1016/j.ciresp.2018.12.003
[17] 汪春绘, 王小琴, 刘良发. 纳米炭混悬液在甲状腺乳头状癌术中的应用研究[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(2): 165-169. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202002016.htm
[18] 双羽, 李超, 黄永望. 前哨淋巴结检测在头颈部肿瘤中的研究进展[J]. 中国眼耳鼻喉科杂志, 2015, 15(1): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH201501028.htm
[19] Garau LM, Rubello D, Ferretti A, et al. Sentinel lymph node biopsy in small papillary thyroid cancer. A review on novel surgical techniques[J]. Endocrine, 2018, 62(2): 340-350. doi: 10.1007/s12020-018-1658-5
[20] Liu F, Zhu Y, Qian Y, et al. Recognition of sentinel lymph nodes in patients with papillary thyroid cancer by nano-carbon and methylene blue[J]. Pak J Med Sci, 2017, 33(6): 1485-1489.
[21] Zhang X, Shen YP, Li JG, et al. Clinical feasibility of imaging with indocyanine green combined with carbon nanoparticles for sentinel lymph node identification in papillary thyroid microcarcinoma[J]. Medicine(Baltimore), 2019, 98(36): e16935.
[22] 陈杰, 周晓红, 李真华, 等. 利用纳米碳与亚甲蓝示踪甲状腺乳头状癌前哨淋巴结的对比研究[J]. 中华细胞与干细胞杂志(电子版), 2017, 7(1): 7-11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGA201701003.htm
[23] 黄璐, 李超, 蔡永聪, 等. 术中甲状旁腺识别与保护技术的研究进展[J]. 中华全科医师杂志, 2019, 18(1): 78-81. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWK202003028.htm
[24] 金辉, 宋晓丹. 纳米碳及亚甲蓝在甲状腺癌手术中的应用[J]. 江苏医药, 2017, 43(2): 144-145. https://www.cnki.com.cn/Article/CJFDTOTAL-YIYA201702023.htm
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