| Purposes/Objectives:To investigate whether localization by 99 m Tc sulfur colloid combined with Carbon Nanoparticles has advantages over traditional localization by methylene blue dye in breast cancer sentinel lymph node biopsy, and discuss its clinical application value.Methods:A total of 97 breast cancer patients undergoing surgery in our hospital from August 2013 to August 2015 were selected as subjects, no enlarged axillary lymph nodes were palpated on admission, and breast cancer was confirmed by pathological biopsy before surgery. All the patients were randomized into two groups on admission: experimental group(49 cases)and control group(48 cases). For the experimental group, SPECT/CT fusion imaging was performed after injection of 99 m Tc sulfur colloid before operation to initially identify the location of sentinel lymph nodes, and ?-ray detector combined with Carbon Nanoparticles staining was used in the operation to find sentinel lymph nodes. For the control group, methylene blue dye was used for the localization of sentinel lymph nodes. The detection rate of sentinel lymph nodes, the number of detected sentinel lymph nodes,the false negative rate, the positive rate, the localization performance of sentinel lymph nodes, the detection rate of positive sentinel lymph nodes, the metastasis of lymph nodes and the learning curve were compared between experimental group and control group to investigate whether the combination of multiple new techniques can better detect the sentinel lymph nodes of breast cancer and discuss its actual clinical application value.Results:Among the 97 breast cancer patients, sentinel lymph nodes were successfully detected in 84 cases, with a total detection rate of 86.60%(84/97). A total of 369 sentinel lymph nodes were detected, and the average number of detected sentinel lymph nodes was 4.6±2.1. There were 29 cases with positive sentinel lymph nodes(i.e. postoperative paraffin pathology confirmed metastasis), 55 cases with negative sentinel lymph nodes(i.e.postoperative paraffin pathology confirmed no metastasis) and 13 cases with no sentinel lymph nodes detected. Confirmed by postoperative pathology,there were 36 cases with positive axillary lymph nodes and 61 cases with negative axillary lymph nodes, and there were 3 false negative cases, with an overall false negative rate of 8.33%(3/36). Among the 49 patients in the experimental group, sentinel lymph nodes were successfully detected in 46 cases, with a total detection rate of 93.88%(46/49). A total of 245 sentinel lymph nodes were detected, and the average number of detected sentinel lymph nodes was 5.2±2.1. There were 19 cases with positive sentinel lymph nodes, 27 cases with negative sentinel lymph nodes and 3 cases with no sentinel lymph nodes detected. Confirmed by postoperative pathology, there were 20 cases with positive axillary lymph nodes and 29 cases with negative axillary lymph nodes, and there was 1 false negative case, with a false negative rate of 5%(1/20). Among the 48 patients in the control group,sentinel lymph nodes were successfully detected in 38 cases, with a total detection rate of 79.16%(38/48). A total of 124 sentinel lymph nodes were detected, and the average number of detected sentinel lymph nodes was3.3±1.6. There were 10 cases with positive sentinel lymph nodes, 28 cases with negative sentinel lymph nodes and 10 cases with no sentinel lymph nodes detected. Confirmed by postoperative pathology, there were 16 cases with positive axillary lymph nodes and 32 cases with negative axillary lymph nodes, and there were 2 false negative cases, with a false negative rate of12.5%(2/16). The detection rate of sentinel lymph nodes and the average number of detected sentinel lymph nodes were higher in the experimental group than in the control group, and the difference was statistically significant(P<0.05). The incidence of incomplete tracing and the incidence of failed tracing were lower in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). For the study of learning curve, the first 20 cases in two groups were taken as the first stage. At the first stage, among the 20 patients in the experimental group,sentinel lymph nodes were successfully detected in 19 cases, with a detection rate of 95%(19/20), there were 7 cases with positive sentinel lymph nodes and 12 cases with negative sentinel lymph nodes, and there was 1 false negative case, with a false negative rate of 12.5%(1/8) and an accuracy of94.73%(18/19). Among the 20 patients in the control group, sentinel lymph nodes were successfully detected in 13 cases, with a detection rate of 65%(13/20), there were 3 cases with positive sentinel lymph nodes and 10 cases with negative sentinel lymph nodes, and there were 2 false negative cases,with a false negative rate of 28.57%(2/7) and an accuracy of 84.61%(11/13).The detection rate of sentinel lymph nodes was higher in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). The accuracy of sentinel lymph node biopsy was higher in the experimental group than in the control group, and the false negative rate was lower in the experimental group than in the control group,but the difference was not statistically significant(P>0.05). However, the detection rate and false negative rate of experimental group at the first stage met the inclusion criteria of sentinel lymph node surgery, while those of the control group did not meet the criteria.Conclusions:When 99 m Tc sulfur colloid combined with Carbon Nanoparticles was used as the tracer for breast cancer sentinel lymph nodes, SPECT/CT fusion imaging, ?-ray detector and Carbon Nanoparticles staining can be combined for the localization of breast cancer sentinel lymph nodes. With more accurate localization performance than simple methylene blue staining, this method can improve the detection rate of sentinel lymph nodes and the number of detected sentinel lymph nodes, as well as reduce the false negative rate of breast cancer sentinel lymph node biopsy. For a team beginning to carry out breast cancer sentinel lymph node biopsy, the combination of SPECT/CT fusion imaging, ?-ray detector and Carbon Nanoparticles staining for the localization of breast cancer sentinel lymph nodes can allow the detection rate and the false negative rate of the team to meet the inclusion criteria of breast cancer sentinel lymph node biopsy more rapidly, and shorten the learning time. |
PDF Full Text Request