目的：探讨联合应用吲哚菁绿（ICG）荧光示踪法与蓝染法行乳腺癌前哨淋巴结活检（SLNB）的可行性。方法：选择2014年3月―2015年10月期间276例乳腺癌患者，其中131例患者应用ICG联合美蓝行SLNB（联合组），145例患者以美蓝为示踪剂行SLNB（美蓝组）。所有患者SLNB结束后均行I、II水平腋窝淋巴清扫。结果：两组基本临床资料差异无统计学意义（均P>0.05）；联合组前哨淋巴结（SLNs）检出率明显高于美蓝组（96.9% vs. 89.7%，P=0.017），平均检出SLNs数目明显多于美蓝组（3.0枚vs. 2.1枚，P=0.011）；假阴性率低于美蓝组（7.1% vs. 10.9%），但差异无统计学意义（P=0.813）。全组数据统计分析显示，SLNs检出个数≤2时的假阴性率明显高于SLNs检出个数≥3时假阴性率（17.5% vs. 2.1%，P=0.033）。结论：ICG荧光示踪法联合蓝染法行乳腺癌SLNB相对于蓝染法有检出率高、SLNs平均检出个数多、淋巴管实时显像的优势，在不具备核素法广泛应用条件时推荐使用。
Combined tracing method of indocyanine green fluorescence and methylene blue dyeing in sentinel lymph node biopsy of breast cancer
Objective: To investigate the feasibility of using combined tracing method of indocyanine green (IGG) fluorescence and methylene blue dyeing in sentinel lymph node biopsy (SLNB) of breast cancer. Methods: Two hundred and seventy-six breast cancer patients admitted between March 2014 and October 2015 were selected. Of the patients, 131 cases underwent SLNB with ICG combined with methylene blue (combination group), while 145 cases underwent SLNB with methylene blue alone (methylene blue group); all cases underwent level I and II axillary lymph node dissection after SLNB. Results: The general clinical data had no statistical difference between the two group of patients (all P>0.05). In combination group, the detection rate of sentinel lymph nodes (SLNs) was significantly higher than that in methylene blue group (96.9% vs. 89.7%, P=0.017), the average number of detected SLNs was significantly greater than that in methylene blue group (3.0 vs. 2.1, P=0.011) and the false negative rate was lower than that in methylene blue group (7.1% vs. 10.9%), but the latter did not reach a statistical significance (P=0.813). Statistical analysis of the data of the whole group showed that the false negative rate between the two groups in cases with detected number of SLNs less than or equal to 2 was significantly higher than in those with detected number of SLNs equal to or more than 3(17.5% vs. 2.1%, P=0.033). Conclusion: Compared with methylene blue dyeing alone, the combined tracing of IGG fluorescence and methylene blue dyeing for SLNB in breast cancer has advantages of high detection rate and average number of detected SLNs as well as real-time lymphatic imaging. So it is recommended to be used under the circumstance of no conventional access for using radionuclide method.