低成本示踪剂在市级医院早期乳腺癌腋窝前哨淋巴结活检中的应用现状

Current Status of Low-Cost Tracers in Axillary Sentinel Lymph Node Biopsy for Early Breast Cancer in Municipal Hospitals

摘要: 近二十年来，乳腺癌腋窝淋巴结的外科处理经历了重大变革——腋窝前哨淋巴结活检(sentinel lymph node biopsy, SLNB)的应用，使得早期无转移的乳腺癌患者避免了ALND，从而减少手术并发症并提升生活质量。SLNB具有精准、微创的特点，可有效评估淋巴结状态，减少不必要的清扫，降低手术风险与并发症发生率。示踪技术的优化直接关系到SLNB的成功率。亚甲蓝(methylene blue, MB)作为一种传统示踪剂，因其价格低廉、扩散迅速、毒性低等优点，被广泛用于SLNB。吲哚菁绿(indocyanine green, ICG)凭借其对红外光的高敏感性，在SLN定位中展现出独特优势。联合应用ICG与MB可进一步提高SLNB的灵敏度与准确性，降低误诊和假阴性率，为患者提供更精准的治疗方案。此外，该联合方法成本相对较低，有利于在市级医院推广应用。本文旨在回顾并探讨市级医院中SLNB技术的应用现状及低成本示踪剂的相关问题。

Abstract: Over the past two decades, surgical management of breast cancer axillary lymph nodes has undergone significant advancements—the implementation of sentinel lymph node biopsy (SLNB) has enabled early-stage, non-metastatic breast cancer patients to avoid ALND procedures, thereby reducing surgical complications and improving quality of life. SLNB’s precision and minimally invasive nature allow effective assessment of lymph node status while minimizing unnecessary dissection, thereby lowering surgical risks and complication rates. Optimization of scintigraphy techniques directly impacts SLNB success rates. Methylene Blue (MB), a traditional tracer, is widely used in SLNB due to its cost-effectiveness, rapid diffusion, and low toxicity. Indocyanine Green (ICG), with its high sensitivity to infrared light, demonstrates unique advantages in SLN localization. Combining ICG with MB enhances SLNB sensitivity and accuracy while reducing misdiagnosis and false-negative rates, enabling more precise treatment plans for patients. Additionally, this combined approach offers relatively lower costs, making it suitable for promotion and application in municipal hospitals. This article aims to review and discuss the current status of SLNB technology applications in municipal hospitals and address challenges related to cost-effective tracers.