摘要
目的通过调查获知国内亚甲蓝作为示踪剂在乳腺癌前哨淋巴结活检术(SLNB)中的应用现状,规范其正确的使用方法。方法2020-08-30-2020-11-30通过问卷星平台(https://www.wjx.cn/)向全国乳腺外科医师发出调查问卷,分别对SLNB示踪方法、亚甲蓝的注射浓度、部位、时机、剂量及单示踪的假阴性率,进行反馈数据的整理分析。结果收到有效问卷669份,涵盖全国各个省、自治区、直辖市(除外西藏、香港、澳门、台湾),全国有76.94%的乳腺外科医生在使用亚甲蓝作为前哨淋巴结示踪剂;亚甲蓝注射部位为乳晕皮内占31.35%;亚甲蓝注射原液占67.48%,浓度为1∶9占16.14%;注射时机选择术前10~15 min占93.66%;注射量2 mL占68.75%;乳晕区注射点数:1个点占34.49%,2个点占27.96%,3个点占36.12%,4个点占30.36%。结论目前国内乳腺外科医师广泛应用亚甲蓝作为前哨淋巴结示踪剂。亚甲蓝的注射浓度、部位及剂量尚存在分歧;注射时机为术前10~15 min,已达成共识。使用原液在乳腺癌手术中缺乏循证医学证据,建议使用容积比1∶9的浓度;亚甲蓝注射部位应在乳晕皮内;注射量建议2 mL;注射点数建议沿乳晕区4个象限分别注射1个点;济川药业集团有限公司亚甲蓝注射液说明书指出,亚甲蓝不能皮下、肌肉、鞘内注射,中国抗癌协会乳腺癌诊治指南与规范(2021年版)指出“蓝染料和核素示踪剂注射于肿瘤表面的皮内或皮下、乳晕区皮内或皮下及原发肿瘤周围的乳腺实质内均有相似的成功率和假阴性率”。两者存在分歧,需要进一步商榷统一。
Objective Through investigation,the domestic application status of methylene blue as a tracer in sentinel lymph node biopsy(SLNB)for breast cancer in China,and standardize its correct use method.Methods From 2020-08-30 to 2020-11-30,a questionnaire was sent to breast surgeons across the country through the wen juan xing platform(https://www.wjx.cn/),respectively to collate and analyze the feedback data of SLNB tracer method,the injection concentration,location,timing,dose of methylene blue,and the false-negative rate of single tracing.Results A total of 669 valid questionnaires were received,covering all provinces,autonomous regions,and municipalities(except Tibet,Hong Kong,Macao,and Taiwan).Methylene blue was used as a sentinel lymph node tracer in 76.94%of breast surgeon in China.Methylene blue injection site:inside the areola skin(31.35%).Methylene blue injection concentration:original solution(67.48%),concentration 1∶9(16.14%).Timing of injection:10-15 minutes before surgery(93.66%).Injection dose:2ml(68.75%).Areola injection points:1point(34.49%),2points(27.96%),3points(36.12%),4points(30.36%).Conclusions At present,methylene blue is widely used as a sentinel lymph node tracer by breast surgeons in China.The injection concentration,site,and dose of methylene blue are still different.It has been agreed that the timing of injection is 10-15minutes before surgery.In this study,it is concluded that the use of raw fluid in breast cancer surgery lacked evidence-based medical evidence,and the concentration of a 1∶9volume ratio is recommended.Methylene blue injection site should be in the areola skin.The recommended injection volume is 2ml.It is recommended to inject 1point along with the four quadrants of the areola area.According to the instructions of Jichuan Pharmaceutical Group Co"methylene blue injection cannot be injected subcutaneously,intramuscularly or intrathecally".The Guidelines and Norms for the Diagnosis and Treatment of Breast Cancer of the Chinese Anti-Cancer Association(2021edition)state that"blue dye and nuclide tracer injection into the intradermal or subcutaneous surface of the tumor,the intradermal or subcutaneous area of the areola and the breast parenchyma around the primary tumor have similar success rates and false negative rates".There are differences between the two,which need to be further discussed and unified.
作者
师泽元
王一帆
代雅琳
陈梦圆
张雅婷
李伟
谢凤鸣
卢海
师丙帅
吴名一
SHI Ze-yuan;WANG Yi-fan;DAI Ya-lin;CHEN Meng-yuan;ZHANG Ya-ting;LI Wei;XIE Feng-ming;LUHai;SHI Bing-shuai;WU Ming-yi(School of Clinical Medicine,Henan University,Zhengzhou 450003,China;Department of Breast and Nail Surgery,the First Affiliated Hospital of Henan University,Kaifeng 475001,China;Second Department of General Surgery,South Yunnan Central Hospital,Mengzi 661100,China;Department of Nail and Breast Surgery,Shaoguan First People's Hospital,Shaoguan 512000,China)
出处
《社区医学杂志》
CAS
2022年第14期814-818,共5页
Journal Of Community Medicine
基金
中国博士后基金(2020M682683)
关键词
亚甲蓝
乳腺癌
前哨淋巴结
示踪技术
问卷调查
methylene blue
breast cancer
sentinel lymph node
tracing technique
questionnaire survey
作者简介
第一作者:师泽元,男,河南开封人,硕士,主要从事肿瘤学疾病诊治的临床研究工作。E-mail:hdyfysbs@163.com;通信作者:吴名一,女,河南平顶山人,硕士,住院医师,主要从事乳腺疾病诊治的临床研究工作。E-mail:1603937172@qq.com
