吲哚菁绿荧光联合纳米碳示踪检测在甲状腺乳头状癌前哨淋巴结定位中的应用

陈鲧; 张星; 丛玲华; 李嘉根

doi:10.16766/j.cnki.issn.1674-4152.001835

吲哚菁绿荧光联合纳米碳示踪检测在甲状腺乳头状癌前哨淋巴结定位中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001835

宁波市鄞州人民医院病理科，浙江宁波 315040

基金项目:

浙江省医药卫生科技计划 2017KY613

详细信息

通讯作者:
陈鲧，E-mail: issomike@sina.com

中图分类号: R736.1 R730.44
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- 被引次数: 0
出版历程
- 收稿日期: 2020-01-05
- 网络出版日期: 2022-02-19

Application value of indocyanine green fluorescence combined with carbon nanotracer in sentinel lymph node localization of papillary thyroid cancer

Department of Pathology, Yinzhou People's Hospital, Ningbo, Zhejiang 315040, China

摘要

摘要: 目的探索吲哚菁绿荧光联合纳米碳示踪检测在甲状腺乳头状癌(papillary thyroid carcinoma，PTC)前哨淋巴结(sentinel lymph node，SLN)定位中的应用价值。方法选择2017年7月—2018年7月在宁波市鄞州人民医院接受手术治疗的PTC患者90例，术中使用吲哚菁绿荧光联合纳米碳活检者60例作为观察组，使用纳米碳活检者30例作为对照组，记录2组SLN的位置及数目，随后行颈淋巴结清扫术。手术切除的前哨淋巴结和其他清扫的淋巴结冷冻作病理检查，比较2组的相关指标。结果 2组患者性别、肿瘤大小、多灶性比较差异均无统计学意义(均P＞0.05);观察组患者SLN检出率、准确度、灵敏度明显高于对照组，假阴性率明显低于对照组，差异具有统计学意义(均P < .05);2组平均检出SLN数目差异无统计学意义(t=0.569，P＞0.05);分析临床病理参数对前哨淋巴结检测的影响，发现患者的性别、年龄、肿瘤大小、多灶性、TNM分期等病理参数对其SLN检出率和准确率均无明显影响，差异无统计学意义(均P＞0.05)。结论吲哚菁绿荧光联合纳米碳作为淋巴结示踪剂具有良好的可视性，SLN检出率高于单用纳米碳，在甲状腺乳头状癌SLN活检术中有较高的应用价值。
- 吲哚菁绿荧光联合纳米碳 /
- 甲状腺乳头状癌 /
- 前哨淋巴结 /
- 应用价值
Abstract: Objective To explore the application value of indocyanine green fluorescence combined with carbon nanotracer in sentinel lymph node (SLN) localization of papillary thyroid cancer (PTC). Methods Ninety patients with PTC who underwent surgery in our hospital from July 2017 to July 2018 were enrolled. Sixty patients with indocyanine green fluorescence combined with carbon nanotracer as observation group, and 30 patients with carbon nanotracer as control group. The location and number of SLNs in both groups were recorded, followed by cervical lymph node dissection. Surgically resected sentinel lymph nodes and other dissected lymph nodes were frozen for pathological examination, relevant indicators were compared between the two groups. Results There was no significant difference in sex, tumor size, multifocal and TNM staging, age, operation time, intraoperative bleeding volume and sentinel lymph node resection time between the two groups (all P>0.05). The detection rate, accuracy and sensitivity of SLN in the observation group were significantly higher than those in the control group, and the false negative rate was significantly lower than that in the control group (all P < .05). There was no significant difference in the average number of SLN detected between the two groups (t=0.569, P>0.05). The influence of clinicopathological parameters on sentinel lymph node detection was analyzed, it was found that the patient's gender, age, tumor size, multifocal, TNM staging and other pathological parameters had no significant effect on SLN detection rate and accuracy (all P>0.05). Conclusion Indocyanine green fluorescence combined with carbon nanotracer has good visibility as a lymph node tracer. The detection rate, accuracy and sensitivity of SLN is significantly higher than that of single-use nano-carbon. It has high application value in SLN biopsy of thyroid papillary carcinoma.
- Indocyanine green fluorescence combined with carbon nanotracer /
- Papillary thyroid carcinoma /
- Sentinel lymph node biopsy /
- Application value

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图 1 光学显微镜下观察SLN形态

注：A为SLN阳性(×100);B为SLN阳性(×400);C为SLN阴性(×100);D为SLN阴性(×400)

下载: 全尺寸图片幻灯片

表 1 2组PTC患者临床资料比较(x±s)

组别	例数	性别(男/女，例)	年龄(岁)	肿瘤大小(＞2/≤2 cm，例)	多灶性(单灶/多灶，例)	TNM分期[(T1~T2) /(T3~T4)，例]	手术时间(min)	术中出血量(mL)	前哨淋巴结切除时间(min)
观察组	60	19/41	38.34±10.12	27/33	32/28	42/18	124.67±42.67	86.55±21.73	29.64±10.57
对照组	30	8/22	39.15±9.76	10/20	18/12	21/9	132.38±39.21	82.43±20.24	31.25±11.03
统计量		0.238^a	0.362^b	1.124^a	0.360^a	< 0.001^a	0.830^b	0.867^b	0.671^b
P值		0.626	0.718	0.289	0.549	0.999	0.409	0.388	0.504
注：^a为χ²值，^b为t值。

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表 2 2组PTC患者前哨淋巴结病理检查结果比较(%)

组别	例数	检出率	SLN数目(x±s，枚)	准确度	灵敏度	假阴性率
观察组	60	98.33(59/60)	4.01±1.06	96.67(58/60)	97.73(43/44)	2.27(1/44)
对照组	30	86.67(26/30)	3.88±0.94	73.33(22/30)	78.95(15/19)	21.05(4/19)
t值			0.569
P值		0.041^a	0.285	0.002^a	0.026^a	0.026^a
注：^a为采用Fisher精确检验。

下载: 导出CSV

表 3 PTC患者临床病理参数对前哨淋巴结检出率及准确率的影响

影响因素	类别	前哨淋巴结检出率(%)	χ²值	P值	前哨淋巴结活检准确率(%)	χ²值	P值
性别	男性	92.59(25/27)	< 0.001	0.986	96.00(24/25)	0.007	0.934
	女性	92.06(58/63)			93.33(56/60)
年龄(岁)	＞35	92.86(52/56)	0.020	0.887	94.00(47/50)	< 0.001	0.992
	≤35	97.06(33/34)			94.29(33/35)
肿瘤大小(cm)	＞2	94.59(35/37)	< 0.001	0.993	97.14(34/35)	0.030	0.863
	≤2	94.34(50/53)			92.00(46/50)
多灶性	单灶	94.00(47/50)	0.001	0.972	89.36(42/47)	0.075	0.784
	多灶	95.00(38/40)			97.37(37/38)
TNM分期	T1、T2期	93.65(59/63)	0.007	0.933	93.22(55/59)	0.008	0.927
	T3、T4期	96.30(26/27)			96.15(25/26)

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