内容紹介
Summary
Clinical evidence has indicated that, after neo—adjuvant chemotherapy(NAC), sentinel node(SN)identification rates(IR)were lower and false—negative rates(FNR)were higher for patients(pts)with local advanced breast cancer(BC)than for pts with early stage BC who did not receive NAC. Our previous clinical trial indicated that the real—time indocyanin green(RT—ICG)fluorescence imaging technique could improve the diagnostic sensitivity and detection accuracy of sentinel node biopsy(SNB). Nine pts with histologically confirmed Stage ⅡA to ⅢB, T1—T3, N0—2, M0 BC were selected to receive NAC, and the standard surgeries were performed after NAC completion. The SNs were detected by using conventional procedures with the blue dye(indigo carmine)plus 99mTc radioisotope techniques combined with concurrent RT—ICG. Clinically positive nodes were diagnosed by the radiologists using axillary ultrasound, MRI, and/or CT scans. All pts provided written informed consent before surgery. The surgical SNB was guided via RT—ICG fluorescence under standard light conditions by using the HEMS imaging system as previously published. All pts underwent SNB followed by completion node dissection(CND). The IR and FNR were calculated by comparing the results of the SNB and the histopathology of the resection specimens obtained via CND. The IR and FNR for each procedure of SNB were, respectively, 35.3% and 41.7% when indigo carmine blue was used, 82.4% and 0 when ICG fluorescence was used, and 58.8% and 5% when RI was used. In contrast, the total calculation of the triple tracer showed that IR reached 100% and FNR was 0. These data suggest that IR and FNR of SNB might be improved in pts with BC treated with NAC by using the novel triple tracer technique.
要旨
乳癌センチネルリンパ節(SN)同定においては色素法とアイソトープ(RI)法を併用する方法が,どちらかの単独法よりわずかに勝っている報告が多く,併用法が標準的であるが単独法も十分許容できる(乳癌診療ガイドライン2018年版)。また,当施設では蛍光法と色素法を併用したSN同定についての検討を行い,同定率100%,組織的感度93.8%と良好な結果を得て,論文報告をしてきた。今回は,色素法,蛍光法,RI法の3種類を併用したtriple tracer法によるSNの同定率および精度について臨床的に解析し,これらの結果を踏まえ術前化学療法(neo—adjuvant chemotherapy:NAC)を必要とする症例に対して本法による臨床研究を開始し,より精度の高いSNの検査法としての可能性を模索する。
目次
Clinical evidence has indicated that, after neo—adjuvant chemotherapy(NAC), sentinel node(SN)identification rates(IR)were lower and false—negative rates(FNR)were higher for patients(pts)with local advanced breast cancer(BC)than for pts with early stage BC who did not receive NAC. Our previous clinical trial indicated that the real—time indocyanin green(RT—ICG)fluorescence imaging technique could improve the diagnostic sensitivity and detection accuracy of sentinel node biopsy(SNB). Nine pts with histologically confirmed Stage ⅡA to ⅢB, T1—T3, N0—2, M0 BC were selected to receive NAC, and the standard surgeries were performed after NAC completion. The SNs were detected by using conventional procedures with the blue dye(indigo carmine)plus 99mTc radioisotope techniques combined with concurrent RT—ICG. Clinically positive nodes were diagnosed by the radiologists using axillary ultrasound, MRI, and/or CT scans. All pts provided written informed consent before surgery. The surgical SNB was guided via RT—ICG fluorescence under standard light conditions by using the HEMS imaging system as previously published. All pts underwent SNB followed by completion node dissection(CND). The IR and FNR were calculated by comparing the results of the SNB and the histopathology of the resection specimens obtained via CND. The IR and FNR for each procedure of SNB were, respectively, 35.3% and 41.7% when indigo carmine blue was used, 82.4% and 0 when ICG fluorescence was used, and 58.8% and 5% when RI was used. In contrast, the total calculation of the triple tracer showed that IR reached 100% and FNR was 0. These data suggest that IR and FNR of SNB might be improved in pts with BC treated with NAC by using the novel triple tracer technique.
要旨
乳癌センチネルリンパ節(SN)同定においては色素法とアイソトープ(RI)法を併用する方法が,どちらかの単独法よりわずかに勝っている報告が多く,併用法が標準的であるが単独法も十分許容できる(乳癌診療ガイドライン2018年版)。また,当施設では蛍光法と色素法を併用したSN同定についての検討を行い,同定率100%,組織的感度93.8%と良好な結果を得て,論文報告をしてきた。今回は,色素法,蛍光法,RI法の3種類を併用したtriple tracer法によるSNの同定率および精度について臨床的に解析し,これらの結果を踏まえ術前化学療法(neo—adjuvant chemotherapy:NAC)を必要とする症例に対して本法による臨床研究を開始し,より精度の高いSNの検査法としての可能性を模索する。