1%亚甲蓝染料作为单一技术在乳腺癌哨点节点活检中的应用
Summary
在印度尼西亚,由于提供放射性同位素示踪剂和异硫酸盐或专利蓝色染料(PBD)的限制,乳腺癌手术不定期进行哨点节点活检(SNB)。为了克服这一障碍,我们应用1%亚甲基蓝色染料(MBD)作为单一剂来映射哨兵节点(SNs)。
Abstract
在这项研究中,我们向乳房的亚耳原或胸周空间注射了1%的亚甲基蓝色染料(MBD)。在吸乳手术(BCS)中,在下部斧头发线中做了一个单独的切口来查找哨点节点(SNs)。在乳房切除术中,SN通过同一乳房切除切口被识别。SN 被描述为蓝色节点或具有淋巴蓝色通道的节点。在斧片的解剖地标被用来促进SN识别。SNs转移是一个黄金标准,通过术中冷冻切片分析和组织病理学检查来评估。在这里,我们描述MBD是乳腺癌哨点节点活检(SNB)中唯一的技术,当无法提供放射性同位素示踪剂或专利或异硫酸盐蓝色染料(PBD)时,该技术可能很有用。
Introduction
肛门淋巴结(ALNs)转移状态是乳腺癌最重要的预后因素。Axill淋巴结解剖(ALND)是评估ALN1,2转移状态的常规程序。不幸的是,ALND导致患者的病态,降低生活质量,特别是通过增加淋巴水肿的风险后,这个程序3,4。如今 , 哨点节点活检 ( SNB ) 已经取代 ALND 为分期 , 因为它在患者中最小的疾病 5 。执行SNB的最常见方法是使用放射性同位素示踪剂和PBD6。在世界某些地区,包括发展中国家,这些示踪剂可能难以采购,寻找替代示踪剂对于解决这一问题至关重要。
最初,MBD被 Wong 等人用作映射哨兵节点 (SN)7的跟踪代理。在使用猫科模型的研究中,MBD的皮内注射显示淋巴摄取不良,而异硫丹蓝被选为哨兵节点(SN)映射7的首选染料。自从西蒙斯等人8日首次成功报告以来,甲基蓝染料已用于乳腺癌SNB。一些研究也报告MBD是SN鉴定的有利染料,MBD技术的假阴性率可与放射性同位素或PBD9、10、11相媲美。减少过敏反应和更低的价格是考虑在SN映射12中使用的其他原因。
最近,我们研究了在临床节点阴性乳腺癌中单独使用1%MBD对SNB。在早期阶段,MBD具有有利的识别率和负预测值13。如果我们在乳房的上外象限或奶嘴复合物 (NAC) 处出现外检活检疤痕,我们向下腹空间或腹肌区域注射 2 mL 的 1% MBD。蓝色节点和带淋巴蓝色通道的非蓝色节点被归类为 SN。在斧片的解剖地标被用作寻找SN的指导。 术中检查用于评估转移和SN被发送到组织病理学分析基于美国临床肿瘤学会(ASCO)指南14。
如果仔细选择病例,并且由外科医生和病理学家获得此技术所需的技能,许多患者可以挽救从ALND的有害影响,同时仍然有良好的生存。
Protocol
所有程序,包括人类受试者,均获得佛法癌症医院伦理委员会的批准,证书号为040/KEPK/VII/2017。所有患者都签署了同意书,并表示同意参与本研究。 注:纳入标准是早期乳腺癌诊断的患者,肿瘤阶段T1-T2无可触手可及和超声检查淋巴结扩大(cNo)。排除标准是局部晚期乳腺癌,接受新佐剂化疗或激素治疗,和怀孕。 1. 1%亚甲蓝染料的制备及注射技术 麻醉病人后,?…
Representative Results
在这里,我们描述从呈现的技术的结果。两毫升1%MBD被注射在深亚罗拉空间作为注射的标准技术(图1A)。如果指示了微体注射,则应在超声波指导下进行(图1B)。进入突经空间后,可以看到蓝色结节或淋巴蓝色区域。继淋巴蓝片后,找到SN(图2A)。如果看不到蓝色结节或淋巴蓝片,我们使用闭周神经和侧胸静脉作为解?…
Discussion
在现代乳腺癌手术时代,瑞士央行已经取代ALND作为早期乳腺癌的乳腺分期护理标准,如果SN没有转移14,15,ALND应该放弃。发达国家常用的淋巴图谱技术是放射性同位素示踪剂和PBD作为组合或单一技术的应用。当无法获得放射性同位素甚至多溴联苯时,提出了如何执行瑞士国民计划的问题。我们描述的仅使用 MBD 的技…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
作者没有什么可透露的。
Materials
| Metiblo 50mg/5ml | Laboratories Sterop NV | BE475217 | Methylene Blue Dye |
| Disposable syringe with needle – 3mL (Luer Lock Tip) | Terumo Europe NV | dvr-3414 | Syringe for Injection |
| ForceTriad energy platform | Medtronic | ForceTriad | Surgical cautery |
| Shandon Cryomatrix embedding resin | Thermo (scientific) | 6769006 | Frozen Section |
| Cryotome FSE | Thermo (scientific) | 77210153 | |
| HistoStar Embedding Workstation | Thermo (scientific) | A81000001 | Histopathological Examination |
| Finesse Me+ | Thermo (scientific) | A77510272 | |
| Gemini AS | Thermo (scientific) | A81500002 | |
| Benchmark GX | Ventana Medical Systems | 750-850 | Immunohistochemistry |
| Benchmark XT | Ventana Medical Systems | 750-700 | |
| Microscope | Olympus | Model BX53 | |
| Ultrasound | Phillips | HD 7XE |
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Citazione di questo articolo
Brahma, B., Putri, R. I., Sari, L., Karsono, R., Purwanto, D. J., Gautama, W., Andinata, B., Haryono, S. J. The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy. J. Vis. Exp. (148), e57201, doi:10.3791/57201 (2019).