Study on methylene blue combined with indocyanine green in lymphatic drainage of breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FENG Yueqing , ZHANG Zhimin , ZHAO Hui

The Second Ward of Head & Neck, Breast Surgery, Central Hospital of Xinxiang, Xinxiang, Henan 453000, P. R. China;

Corresponding?author：

FENG Yueqing, Email: 15637359823@163.com

Keywords：

breast cancer; lymphatic drainage; indocyanine green; methylene blue

DOI：

10.7507/1007-9424.201906021

Video：

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Objective To investigate the anatomical characteristics of breast lymphatic drainage in patients with breast cancer after injecting methylene blue and indocyanine green (ICG) into the intradermis of the areola.Methods One hundred and eighty-six patients with stage 0–Ⅱ breast cancer were collected. The sentinel lymph node (SLN) biopsy was performed by injecting methylene blue and ICG. At the same time, the number of sentinel lymphatic channel (SLC), origin angle, direction, and consistency were also studied.Results A total of 308 SLCs were successfully showed in the 186 patients and 679 SLNs were detected. The 95.8% (295/308) of SLCs and 93.1% (632/679) of SLNs were showed by combination in the methylene blue and ICG. The 46.8% (87/186) of patients had 1 SLC, the 40.9% (76/186) of patients had 2 SLCs, the 12.4% (23/186) of patients had 3 SLCs. The 82.8% (255/308) of SLCs flowed from the outer upper edge of the areola, the 3.2% (10/308) of SLCs flowed from the outer lower edge of the areola, the 14.0% (43/308) of SLCs flowed from the inner upper edge of the areola. The 89.9% (277/308) of the SLCs flowed mainly through the 0°—60° interval in the outer upper quadrant, 10.1% (31/308) of the SLCs flowed through the 61°—90° interval in the outer upper quadrant.Conclusions The consistency of SLC and SLN stained by the two tracers is good. The number of SLC is 1–3. The SLCs flow mainly through the 0°—60° interval in the outer upper quadrant of the breast, then flow into in the axilla and don’t flow into the internal mammary lymph nodes. The deep superficial lymphatic channels under the skin and the penetrating lymphatic channels can not be showed by ICG, but the SLN can be showed by it.

Citation： FENG Yueqing, ZHANG Zhimin, ZHAO Hui. Study on methylene blue combined with indocyanine green in lymphatic drainage of breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1298-1303. doi: 10.7507/1007-9424.201906021 Copy

1.	中華醫學會外科學分會乳腺外科學組. 早期乳腺癌染料法前哨淋結活檢專家共識及技術操作指南(2018版). 中國實用外科雜志, 2018, 38(8): 885-858.
2.	Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2014, 32(13): 1365-1383.
3.	中華醫學會腫瘤學分會乳腺癌學組. 乳腺癌熒光示蹤前哨淋巴結活組織檢查操作指南. 中華乳腺病雜志(電子版), 2017, 11(4): 193-197.
4.	中華人民共和國國家衛生健康委員會醫政醫管局. 乳腺癌診療規范(2018年版). http://www.nhfpc.gov.cn/zwgk/wenji/list.shtml 2018-12-21.
5.	Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg, 2001, 192(3): 399-409.
6.	Suami H, Pan WR, Taylor GI. Historical review of breast lymphatic studies. Clin Anat, 2009, 22(5): 531-536.
7.	Suami H, Pan WR, Mann GB, et al. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol, 2008, 15(3): 863-871.
8.	Turner-Warwick RT. The lymphatics of the breast. Br J Surg, 1959, 46: 574-582.
9.	Halsell JT, Smith JR, Bentlage CR, et al. Lymphatic drainage of the breast demonstrated by vital dye staining and radiography. Ann Surg, 1965, 162: 221-226.
10.	Wang M, Zhou W, Zhao Y, et al. A novel finding of sentinel lymphatic channels in early stage breast cancer patients: which may influence detection rate and false-negative rate of sentinel lymph node biopsy. PLoS One, 2012, 7(12): e51226.
11.	賀青卿, 姜軍, 楊新華, 等. 乳腺癌淋巴引流途徑的臨床研究. 中華乳腺病雜志(電子版), 2008, 2(2): 140-148.
12.	Kern KA. Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye. J Am Coll Surg, 1999, 189(6): 539-545.
13.	Kern KA. Lymphoscintigraphic anatomy of sentinel lymphatic channels after subareolar injection of technetium 99m sulfur colloid. J Am Coll Surg, 2001, 193(6): 601-608.
14.	王水, 劉曉安, 趙佳, 等. 染料法乳腺癌前哨淋巴通道的研究. 中華外科雜志, 2006, 44(11): 748-750.
15.	王水, 劉曉安, 趙佳, 等. 聯合法觀察前哨淋巴通道的臨床研究. 中華乳腺病雜志(電子版), 2007, 1(1): 35-38.
16.	Wang Y, Zhou W, Li C, et al. Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients. World J Surg Oncol, 2017, 15(1): 127.
17.	趙佳, 王水, 劉曉安, 等. 核素法行乳腺癌前哨淋巴通道顯像的研究. 現代腫瘤醫學, 2009, 17(6): 1060-1062.
18.	Suami H, Taylor GI, Pan WR. A new radiographic cadaver injection technique for investigating the lymphatic system. Plast Reconstr Surg, 2005, 115(7): 2007-2013.
19.	Suami H, O’Neill JK, Pan WR, et al. Superficial lymphatic system of the upper torso: preliminary radiographic results in human cadavers. Plast Reconstr Surg, 2008, 121(4): 1231-1239.
20.	Polom K, Murawa D, Rho YS, et al. Current trends and emerging future of indocyanine green usage in surgery and oncology: a literature review. Cancer, 2011, 117(21): 4812-4822.
21.	李盼盼, 王永勝. 乳腺癌前哨淋巴結活檢術新型示蹤劑的研究進展. 中國癌癥雜志, 2016, 26(12): 1031-1036.
22.	Zhang X, Li Y, Zhou Y, et al. Diagnostic performance of indocyanine green-guided sentinel lymph node biopsy in breast cancer: A meta-analysis. PLoS One, 2016, 11(6): e0155597.
23.	Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol, 2014, 15(8): e351-e362.
24.	駱成玉. 乳腺癌治療從標準到精準微創. 首都醫科大學學報, 2016, 37(3): 331-335.
25.	邵志敏, 余科達. 乳腺外科的發展趨勢. 中國普外基礎與臨床雜志, 2007, 14(3): 252-254.
26.	Zurrida S, Veronesi U. Milestones in breast cancer treatment. Breast J, 2015, 21(1): 3-12.
27.	中國抗癌協會乳腺癌專業委員會. 中國抗癌協會乳腺癌診治指南與規范(2017版). 中國癌癥雜志, 2017, 27(9): 695-760.
28.	王永勝. 乳腺癌前哨淋巴結活檢: 共識與展望. 中國普外基礎與臨床雜志, 2009, 16(7): 505-509.
29.	王杰, 王昕, 王文彥, 等. 乳腺腫物局部切除術后乳腺癌前哨淋巴結活檢的可行性分析. 中華腫瘤雜志, 2016, 38(7): 548-551.
30.	崔志超, 王宇, 趙亞婷, 等. 乳腺癌切檢術后前哨淋巴結活檢的研究. 河北醫藥, 2011, 33(24): 3707-3708.
31.	勞玲玲, 黃小娥, 呂峰, 等. 早期乳腺癌腫塊切除行病理活檢后前哨淋巴結活檢的可行性研究. 現代實用醫學, 2018, 30(1): 67-68.
32.	陳翔, 王水. 乳腺癌前哨淋巴結活檢研究現狀及進展. 中國普外基礎與臨床雜志, 2011, 18(1): 98-102.

1. 中華醫學會外科學分會乳腺外科學組. 早期乳腺癌染料法前哨淋結活檢專家共識及技術操作指南(2018版). 中國實用外科雜志, 2018, 38(8): 885-858.
2. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol, 2014, 32(13): 1365-1383.
3. 中華醫學會腫瘤學分會乳腺癌學組. 乳腺癌熒光示蹤前哨淋巴結活組織檢查操作指南. 中華乳腺病雜志(電子版), 2017, 11(4): 193-197.
4. 中華人民共和國國家衛生健康委員會醫政醫管局. 乳腺癌診療規范(2018年版). http://www.nhfpc.gov.cn/zwgk/wenji/list.shtml 2018-12-21.
5. Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll Surg, 2001, 192(3): 399-409.
6. Suami H, Pan WR, Taylor GI. Historical review of breast lymphatic studies. Clin Anat, 2009, 22(5): 531-536.
7. Suami H, Pan WR, Mann GB, et al. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol, 2008, 15(3): 863-871.
8. Turner-Warwick RT. The lymphatics of the breast. Br J Surg, 1959, 46: 574-582.
9. Halsell JT, Smith JR, Bentlage CR, et al. Lymphatic drainage of the breast demonstrated by vital dye staining and radiography. Ann Surg, 1965, 162: 221-226.
10. Wang M, Zhou W, Zhao Y, et al. A novel finding of sentinel lymphatic channels in early stage breast cancer patients: which may influence detection rate and false-negative rate of sentinel lymph node biopsy. PLoS One, 2012, 7(12): e51226.
11. 賀青卿, 姜軍, 楊新華, 等. 乳腺癌淋巴引流途徑的臨床研究. 中華乳腺病雜志(電子版), 2008, 2(2): 140-148.
12. Kern KA. Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye. J Am Coll Surg, 1999, 189(6): 539-545.
13. Kern KA. Lymphoscintigraphic anatomy of sentinel lymphatic channels after subareolar injection of technetium 99m sulfur colloid. J Am Coll Surg, 2001, 193(6): 601-608.
14. 王水, 劉曉安, 趙佳, 等. 染料法乳腺癌前哨淋巴通道的研究. 中華外科雜志, 2006, 44(11): 748-750.
15. 王水, 劉曉安, 趙佳, 等. 聯合法觀察前哨淋巴通道的臨床研究. 中華乳腺病雜志(電子版), 2007, 1(1): 35-38.
16. Wang Y, Zhou W, Li C, et al. Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients. World J Surg Oncol, 2017, 15(1): 127.
17. 趙佳, 王水, 劉曉安, 等. 核素法行乳腺癌前哨淋巴通道顯像的研究. 現代腫瘤醫學, 2009, 17(6): 1060-1062.
18. Suami H, Taylor GI, Pan WR. A new radiographic cadaver injection technique for investigating the lymphatic system. Plast Reconstr Surg, 2005, 115(7): 2007-2013.
19. Suami H, O’Neill JK, Pan WR, et al. Superficial lymphatic system of the upper torso: preliminary radiographic results in human cadavers. Plast Reconstr Surg, 2008, 121(4): 1231-1239.
20. Polom K, Murawa D, Rho YS, et al. Current trends and emerging future of indocyanine green usage in surgery and oncology: a literature review. Cancer, 2011, 117(21): 4812-4822.
21. 李盼盼, 王永勝. 乳腺癌前哨淋巴結活檢術新型示蹤劑的研究進展. 中國癌癥雜志, 2016, 26(12): 1031-1036.
22. Zhang X, Li Y, Zhou Y, et al. Diagnostic performance of indocyanine green-guided sentinel lymph node biopsy in breast cancer: A meta-analysis. PLoS One, 2016, 11(6): e0155597.
23. Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol, 2014, 15(8): e351-e362.
24. 駱成玉. 乳腺癌治療從標準到精準微創. 首都醫科大學學報, 2016, 37(3): 331-335.
25. 邵志敏, 余科達. 乳腺外科的發展趨勢. 中國普外基礎與臨床雜志, 2007, 14(3): 252-254.
26. Zurrida S, Veronesi U. Milestones in breast cancer treatment. Breast J, 2015, 21(1): 3-12.
27. 中國抗癌協會乳腺癌專業委員會. 中國抗癌協會乳腺癌診治指南與規范(2017版). 中國癌癥雜志, 2017, 27(9): 695-760.
28. 王永勝. 乳腺癌前哨淋巴結活檢: 共識與展望. 中國普外基礎與臨床雜志, 2009, 16(7): 505-509.
29. 王杰, 王昕, 王文彥, 等. 乳腺腫物局部切除術后乳腺癌前哨淋巴結活檢的可行性分析. 中華腫瘤雜志, 2016, 38(7): 548-551.
30. 崔志超, 王宇, 趙亞婷, 等. 乳腺癌切檢術后前哨淋巴結活檢的研究. 河北醫藥, 2011, 33(24): 3707-3708.
31. 勞玲玲, 黃小娥, 呂峰, 等. 早期乳腺癌腫塊切除行病理活檢后前哨淋巴結活檢的可行性研究. 現代實用醫學, 2018, 30(1): 67-68.
32. 陳翔, 王水. 乳腺癌前哨淋巴結活檢研究現狀及進展. 中國普外基礎與臨床雜志, 2011, 18(1): 98-102.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on methylene blue combined with indocyanine green in lymphatic drainage of breast cancer

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