Application and prognostic value of indocyanine green combined with highly sensitive fluorescence image-guided surgery system in breast-conserving surgery of breast cancer
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摘要:
目的 探讨吲哚菁绿（ICG）联合高灵敏荧光影像引导手术系统在乳腺癌保乳手术中的应用价值。 方法 选择2017年5月~ 2020年10月于南京医科大学附属江苏盛泽医院治疗的腋窝淋巴结阴性原发性乳腺癌患者91例。根据ICG术中定位方式的不同，将患者分为对照组（术前金属导丝定位引导，n=33）和观察组（ICG定位引导，n=58）。记录两组患者手术时间、手术切缘是否干净、切缘宽度、肿瘤大小（平均体积），并观察患者术后血清肿瘤指标糖类抗原15-3和癌胚抗原、预后无局部复发生存率、无病生存率及总生存率。 结果 与对照组比较，观察组切缘阳性、肿瘤切除体积、手术时间、术后血清糖类抗原15-3和癌胚抗原水平，无病生存率和总生存率组间的差异无统计学意义（P>0.05），而肿瘤切缘≤2 mm数量增多，无局部复发生存率升高，组间差异有统计学意义（P < 0.05）。 结论 ICG联合高灵敏荧光影像引导手术系统可明显减少乳腺癌手术切缘宽度，且患者预后良好。 -
关键词:
- 吲哚菁绿 /
- 高灵敏荧光影像引导手术系统 /
- 乳腺癌 /
- 保乳术
Abstract:Objective To explore the application value of indocyanine green (ICG) combined with highly sensitive fluorescence image- guided surgery system in breast- conserving surgery for breast cancer. Methods A total of 91 patients with axillary lymph node-negative primary breast cancer who came to Affiliated Jiangsu Shengze Hospital of Nanjing Medical University for treatment from May 2017 to October 2020 were selected. According to the different methods of ICG intraoperative localization, the patients were divided into control group (preoperative metal guide wire localization guidance, n=33) and observation group (ICG localization guidance, n=58). The operation time, whether the surgical margin was clean, the width of the resection margin, and the tumor size (average volume) of the two groups were recorded, postoperative serum tumor index CA15- 3 and carcinoembryonic antigen, and the prognosis survival without local recurrence, disease- free survival rate and overall survival rate were observed. Results Compared with the control group, there were no significant differences between observation groups in positive margins, tumor resection volume, operation time, serum CA15-3 and carcinoembryonic antigen levels after operation, disease-free survival rate and overall survival rate (P>0.05), while the number of tumor margins ≤2 mm and survival rate without local recurrence increased, and the difference between groups was statistically significant (P < 0.05). Conclusion ICG combined with highly sensitive fluorescence image-guided surgery system can effectively reduce the width of breast cancer surgical margins, and the patients'prognosis is good. -
表 1 两组一般资料比较
Table 1. Comparison of general data between the two groups [n(%)]
General data Control group(n=33) Observation group(n=58) t/χ2/Z P Age (years, Mean±SD) 49.00±11.35 47.62±11.82 0.543 0.589 Tumor diameter[cm, M(P25, P75)] 1.3(0.5, 2.0) 1.4(0.9, 2.2) 1.058 0.290 TNM 0.406 0.524 T1 20(60.61) 39(67.24) T2 13(39.39) 19(32.76) Grade 1.129 0.569 Ⅰ 10(30.30) 24(41.38) Ⅱ 18(54.55) 26(44.83) Ⅲ 5(15.15) 8(13.79) Classification 1.293 0.524 Invasive ductal carcinoma 20(60.61) 28(48.28) Invasive lobular carcinoma 11(33.33) 25(43.10) Others 2(6.06) 5(8.62) Estrogen receptor 0.219 0.639 Negative 13(39.39) 20(34.48) Positive 20(60.61) 38(65.52) HER-2 0.067 0.796 Negative 28(84.85) 48(82.76) Positive 5(15.15) 10(17.24) 
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表 2 两组患者手术相关指标比较
Table 2. Comparison of surgery-related indexes between the two groups
Index Control group (n=33) Observation group (n=58) χ2/Z P Surgical margins (%) 0.051 0.821 Positive 12.12(4/33) 13.79 (8/58) Negative 87.88(29/33) 86.21 (50/58) Resection volume [cm3, M(P25, P75)] 67.5(40.2, 91.3) 57.7(42.2, 70.8) 1.841 0.066 Operation time [min, M(P25, P75)] 43(34, 50) 37(30, 50) 1.070 0.285 Margin distance (mm, %) 10.974 0.004 < 1 51.52(17/33) 39.66 (23/58) 1-2 18.18(6/33) 50.00 (29/58) 2 30.30(10/33) 10.34(6/58)
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表 3 两组患者术后血清肿瘤指标CA15-3和CEA比较
Table 3. Comparison of the postoperative serum tumor indexes CA15-3 and CEA between the two groups [M(P25, P75)]
Index Control group (n=33) Observation group (n=58) Z1 P1 Z2 P2 15 d 30 d 15 d 30 d CA15-3 (U/mL) 20.15(18.55, 21.14) 23.07(20.42, 24.85) 20.55(18.20, 22.34) 23.83(21.16, 26.45) -1.255 0.210 -1.048 0.294 CEA (ng/mL) 2.21(2.10, 2.32) 2.17(1.97, 2.28) 2.25(2.09, 2.34) 2.14(2.01, 2.26) -1.610 0.107 -0.095 0.924 CA15-3: Cancer antigen 15-3; CEA: Carcinoembryonic antigen; Z1, P1: Control group (15 d) vs observation group (15 d); Z2, P2: Control group (30 d) vs observation group (30 d).
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表 4 两组患者无局部复发生存率、无病生存率及总生存率比较
Table 4. Comparison of loco-regional free survival rate, disease free survival rate and overall survival rate between the two groups (%)
Index Control group(n=33) Observation group(n=58) χ2 P Prognosis without local recurrence 69.70(23/33) 87.93(51/58) 4.603 0.032 Disease-free survival rate 75.76(25/33) 79.31 (46/58) 1.155 0.694 Overall survival rate 96.97(32/33) 100 (58/58) 3.053 0.081
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