国产纳米炭混悬液在恶性肿瘤前哨淋巴结活检中的应用进展

doi:10.3760/cma.j.cn371439-20220816-00004

摘要/Abstract

摘要：

前哨淋巴结（SLN）是原发肿瘤淋巴结转移必经的首站淋巴结，各类示踪剂是目前SLN领域的研究热点。国产纳米炭混悬液（CNP）作为第三代特异性淋巴示踪剂，具有良好的淋巴系统趋向性，能在短时间内对淋巴结进行染色且不进入血液循环，在各类恶性肿瘤中得到了广泛应用。虽然仍有不少因素会影响到CNP示踪的有效性，但与其余种类示踪剂相比具有安全高效、无放射性、操作简便等优势，有望成为识别恶性肿瘤SLN转移的有力手段。

关键词: 肿瘤, 淋巴结, 纳米粒子

Abstract:

Sentinel lymph nodes （SLNs） are the first lymph nodes to undergo lymph node metastasis from primary tumors， and various tracers are currently being researched in the field of SLNs. Domestic carbon nanoparticles suspension （CNP） has a good lymphatic system tropism， can indeed stain lymph nodes in a short time without entering the blood circulation， and has been widely used in various malignant tumors as a third generation specific lymphatic tracer. Although there are still many factors that affect the effectiveness of CNP tracer， CNP has the advantages of safety， high efficiency， non-radioactivity and easy operation compared with other kinds of tracers， and is expected to be a powerful means to identify SLNs metastasis of malignant tumors.

Key words: Neoplasms, Lymph node, Nanoparticles

王熠昕, 曹蒙, 王焱. 国产纳米炭混悬液在恶性肿瘤前哨淋巴结活检中的应用进展[J]. 国际肿瘤学杂志, 2023, 50(1): 22-27.

Wang Yixin, Cao Meng, Wang Yan. Application progress of domestic carbon nanoparticles suspension in sentinel lymph node biopsy for malignant tumors[J]. Journal of International Oncology, 2023, 50(1): 22-27.

图/表 1

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参考文献 37

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示踪剂名称	淋巴特异性	操作难易	准确性	试剂费用	安全性	设备要求	其他特点
CNP	高	容易	高	较高	安全	简单，无需专用显像设备	颗粒小，在光学显微镜下不可见，可避免掩盖组织，在病理阅片时更有优势^[29]。在淋巴组织中停留时间长，稳定性高
生物蓝染料	较低	较难	较低	便宜	安全	简单，无需专用显像设备	注射后可进入毛细淋巴管和毛细血管，使淋巴管、淋巴结、组织间隙等广泛染色，对淋巴管的即刻显影效果较好^[30]。但转移速度较快，极易转移至下一级淋巴结从而干扰SLN的判断^[25]
ICG	较高	复杂	较高	便宜	安全	较高，需要近红外成像仪	荧光信号穿透距离有限，对肥胖患者显影效果欠佳^[31]。其量子域较低且粒径小导致其在淋巴结停留时间短，随后进入血液循环代谢，减弱了其荧光信号从而影响检出率^[32]
放射性核素（⁹⁹Tc^m）	较高	复杂	高	高	有放射性	高，需要γ探测仪	通过深部组织穿透信号，结合术前影像学来定位SLN的位置，使术中定位准确，可降低不必要的损伤^[33]。用SPECT同机融合断层显像技术可以对核素法进行优化^[29]
联合示踪（核素+蓝染料）	高	复杂	高	高	有放射性	高，需要γ探测仪	是目前SLN检测的金标准^[34]。核素在淋巴结中停留时间较长，术前用探测仪标记核素聚集及淋巴结位置，术中注射蓝染料方便手术直观操作^[35]