纳米炭和吲哚菁绿在早期子宫颈癌治疗中的示踪效果比较

Comparison of Tracing Effects between Nanocarbon and Indocyanine Green in the Treatment of Early Cervical Cancer

摘要: 目的：比较纳米炭、吲哚菁绿在早期宫颈癌中示踪前哨淋巴结(SLN)的应用效果，探索两种示踪剂的示踪效果，为临床工作选择示踪剂提供更多参考。方法：选取2019年6月至2023年10月青岛大学附属医院妇科收治的经病理证实的73例早期宫颈癌需手术治疗的患者为研究对象，所有病例术中均给予宫颈注射纳米炭、吲哚菁绿进行前哨淋巴结(SLN)示踪，对两种示踪剂的显影情况和SLN的示踪效果进行对比分析。所有患者均行(腹腔镜或开腹)广泛全子宫切除术及盆腔淋巴结清扫术 ± 腹主动脉旁淋巴结清扫术，根据使用的SLN示踪剂种类将患者分为纳米炭组(n = 40)、吲哚菁绿组(n = 33)，宫颈注射示踪剂后识别最先黑染的淋巴结或荧光镜下识别紫色荧光淋巴结为SLN，切除SLN后送快速冰冻病理检查，后行广泛全子宫切除术及盆腔淋巴结清扫术，切除的所有淋巴结皆行常规病理学检查和(或)免疫组织化学染色。结果：纳米炭组的SLN总检出率为90% (36/40)、灵敏度为80% (4/5)、假阴性率20% (1/5)、阴性预测值为97% (32/33)；吲哚菁绿组的SLN总检出率为100% (33/33)、灵敏度100% (3/3)、假阴性率0、阴性预测值为100% (30/30)，对比两组总检出指标，吲哚菁绿组表现较优，但P = 0.049，无显著差异。结论：早期子宫颈癌患者应用纳米炭或吲哚菁绿进行SLN示踪技术，具有较高的检出率和准确率，两者均为可行的示踪方法，在实际临床应用中，吲哚菁绿示踪剂相较纳米炭组表现更优异，可根据实际情况加以选择。

Abstract: Objective: To compare the application effects of nanocarbon and indocyanine green in tracking sentinel lymph nodes (SLN) in early cervical cancer, explore the tracing effects of the two tracers, and provide a reference for selecting tracers for clinical work. Methods: 73 patients with early-stage cervical cancer admitted to the Department of Gynecology, Qingdao University Affiliated Hospital from June 2019 to June 2023 were selected as the research subjects. All cases underwent cervical injection of nanocarbon and indocyanine green for sentinel lymph node (SLN) tracing. The development conditions of the two tracers and the tracing effect of SLN were analyzed. All patients underwent extensive hysterectomy (laparoscopic or open) and pelvic lymph node dissection. According to the SLN tracer used, the patients were divided into nanocarbon group (n = 40) and indocyanine green group (n = 33). After injecting a tracer into the cervix, the first black-stained lymph node or the purple fluorescent lymph node identified under fluoroscopy is the SLN. The SLN is removed and sent for rapid pathological examination, and then extensive hysterectomy and pelvic lymph node dissection are performed. All lymph nodes underwent routine pathological examination and/or immunohistochemical staining. Results: The total detection rate of SLN in the nanocarbon group was 90% (36/40), sensitivity was 80% (4/5), the false negative rate was 20% (1/5) and negative predictive value was 97% (32/33). The indocyanine green group had a total SLN detection rate of 100% (33/33), sensitivity of 100% (3/3), false negative rate of 0, and negative predictive value of 100% (30/30). Comparing the total detection rate of the two groups, the indocyanine green group performed better, but P = 0.049, and the difference was not statistically significant. Conclusion: When patients with early cervical cancer use nanocarbon or indocyanine green tracers, the developed SLN has a high detection rate and accuracy, and both are relatively feasible tracing methods. In actual clinical applications, indocyanine green tracer performs better and can be selected according to actual conditions.