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目的:通过与1%异硫蓝(1%isosulfan blue,IB)比较,探讨亚甲蓝(methylene blue,MB)作为示踪剂行乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的价值。方法:206例T1、T2乳腺癌患者,随机分为IB组和MB组。分别利用1%IB和MB染色寻找着色的前哨淋巴结(sentinel lymph node,SLN),然后行SLNB,再行乳腺癌改良根治术,全部标本送病理检查。8只雌性成年大耳白家兔随机分IB组和MB组,利用不同染料观察腋窝淋巴结染色的时间、枚数以及退色的时间。结果:206例中,IB组102例检出SLN 94例(92.16%),SLNB的灵敏度为93.94%(31/33),准确率为90.2%(92/102),假阴性率为6.06%(2/33),假阳性率为0。MB组104例检出SLN 97例(93.27%),灵敏度为93.75%(30/32),准确率为91.35%(95/104),假阴性率为6.25%(2/32),假阳性率为0。2组间差异无显著性(P>0.05)。所有患者未发现与IB和MB相关的不良反应。实验部分:注射IB和MB后腋窝淋巴结染色的平均时间分别为8.75 s和13.13 s,前者淋巴结染色的时间明显短于MB组(P=0.000)。IB组可观察到的淋巴结26枚,染色25枚;MB组27枚,染色11枚,IB组染色的淋巴结枚数明显多于MB组(P=0.000)。淋巴结退色时间,IB组55.00 min,MB组108.75 min,IB组淋巴结退色的时间明显快于MB组(P=0.000)。结论:选择MB行乳腺癌SLNB的临床价值与1%IB基本一致,且MB费用低廉,易于购买。MB可以作为IB的替代。
Objective: To compare the value of methylene blue (MB) as a tracer for sentinel lymph node biopsy (SLNB) in comparison with 1% isothio blue (IBS). Methods: 206 patients with T1 and T2 breast cancer were randomly divided into IB group and MB group. Stained sentinel lymph nodes (SLNs) were stained with 1% IB and MB respectively, followed by SLNB, and the modified radical mastectomy was performed. All specimens were sent for pathological examination. Eight female adult white rabbits were randomly divided into IB group and MB group. Different dyes were used to observe the time and number of the axillary lymph node staining and the time of discoloration. RESULTS: Of the 206 patients, 94 (92.16%) had SLN detected in 102 patients in the IB group. The sensitivity of SLNB was 93.94% (31/33), the accuracy rate was 90.2% (92/102), and the false negative rate was 6.06% ( 2/33), the false positive rate is 0. In the MB group, 97 cases (93.27%) of SLN were detected, the sensitivity was 93.75% (30/32), the accuracy rate was 91.35% (95/104), and the false negative rate was 6.25% (2/32). The false positive rate It was 0. There was no significant difference between the two groups (P>0.05). All patients did not find adverse reactions associated with IB and MB. In the experimental part, the average time of axillary lymph node staining after injection of IB and MB was 8.75 s and 13.13 s, respectively. The lymph node staining time of the former was significantly shorter than that of the MB group (P=0.000). In the IB group, 26 lymph nodes were observed, 25 were stained, 27 were in the MB group, and 11 were stained. The number of lymph nodes stained in the IB group was significantly more than that in the MB group (P=0.000). The lymph node discoloration time was 55.00 min in group IB and 108.75 min in group MB. The time of discoloration of lymph nodes in group IB was significantly faster than that in group MB (P=0.000). Conclusion: The clinical value of breast cancer SLNB with MB line is basically the same as 1% IB, and the MB cost is low and it is easy to purchase. MB can be used as an alternative to IB.