Application of indocyanine green-rituximab in preparation of breast cancer sentinel node tracer

Abstract

The invention discloses an application of indocyanine green-rituximab in preparation of a breast cancer sentinel node tracer. When sentinel node biopsy is carried out via an indocyanine green-rituximab coupled specific tracer, since the specific tracer only fluorescently develops the sentinel node and develops no secondary lymph node, the sentinel node does not need to be found along the fluorescently developed lymphatic in the biopsy, the position of the fluorescently developed sentinel node is detected by an infrared fluorescent development system in a surgery, and the sentinel node positioned by fluorescent development is directly dissected and detected after dissecting and dissociating the peripheral tissues of the sentinel node, so as to avoid the situations of leak detection of the sentinel node and fluorescent development pollution of the peripheral tissues.

Description

Technical field [0001] The invention relates to an application of indocyanine green-rituximab to prepare a specific tracer for breast cancer sentinel lymph node. Background technique [0002] The sentinel lymph node is the first lymph node of breast cancer metastasis, and its pathological condition has important guiding value for the surgical operation and comprehensive treatment of breast cancer. Sentinel lymph node biopsy is a technical method for breast cancer lymph node staging, and accurate positioning of the sentinel lymph node is a technical field that has been focused on in the research of breast cancer sentinel lymph node biopsy. Traditional tracers for sentinel lymph node location include dyes, nuclides, fluorescence, etc., which are all non-specific tracers. Among them, the dye method (methylene blue, patent blue and nano carbon) locates the sentinel lymph node mainly by injecting the dye around the primary breast tumor and / or subcutaneously before the operation, and ...

AI Technical Summary

Problems solved by technology

Among them, the dye method (methylene blue, patent blue and nano-carbon) locates the sentinel lymph node mainly through the preoperative dye around the primary breast tumor and (or) subcutaneously injecting the dye, and then following the dye-stained lymphatic vessels in the axillary area for fine dissection Find the first stained lymph node to determine the specific location of the sentinel lymph node. However, this method requires superb surgical anatomy skills, and there is still a high false-negative rate of sentinel lymph node biopsy after the learning curve, which leads to sentinel lymph node biopsy. The accuracy of the method is difficult to grasp; while the nuclide method ( 99m Tc-sulfur colloid) is used to locate the sentinel lymph node by preoperatively injecting radionuclide into the glands around the primary breast tumor and (or) subcutaneously, and then use the gamma detector to detect the radioactive count during the operation, and find the lymph node with a high count according to the radioactive count , so as to determine the specific location of the sentinel lymph node (lymph node greater than 10% of the highest radioactive count), although this method of sentinel lymph node biopsy has high accuracy and good specificity, but there are risks of radionuclide contamination and radiation damage to medical staff during actual operation problems, and the sulfur colloid has not been approved by the China Food and Drug Administration, which limits its promotion and use in clinical practice; the method of locating sentinel lymph nodes by fluorescence method (indocyanine green) is similar to the dye method, mainly After the preoperative injection of a fluorescent tracer around the primary breast tumor and / or subcutaneously, the first lymph node that is positive for fluorescence imaging is found by using a near-infrared fluorescence imaging device to follow the bright lymph vessels of fluorescence imaging during surgery , so as to locate the specific location of the sentinel lymph node. However, since the fluorescent tracer molecules need to be excited by a near-infrared light source, the penetration of the fluorescent light released by the excited is only about 9mm, so it is difficult to find the deep lymphatic vessels during the biopsy , resulting in the missed detection of sentinel lymph nodes. Although the shallower lymphatic vessels can be clearly detected by fluorescence imaging, the fluorescent tracer in them leaks out together with the lymph fluid after they are disconnected, which can easily cause fluorescence in the tissues around the lymphatic vessels. This is not an ideal sentinel lymph node tracer.

In addition, current specific sentinel lymph node imaging agents 99m The preparation process of Tc-rituximab is relatively complicated, and it needs to go through steps such as antibody modification, separation after modification, antibody packaging, antibody labeling, separation and purification, etc. Exposure to radioactive substances can easily cause radiation damage to experimental technicians, surgeons, pathologists and other related personnel. In addition, the labeling rate of rituximab and radionuclides prepared by this method is sometimes only 90%, which is difficult to meet Sentinel lymph node imaging and positioning requirements may easily lead to inaccurate imaging

[0003] The currently existing combination products of rituximab and indocyanine green are only used for the diagnosis of ex vivo cell detection, and have not been applied in the imaging and localization of sentinel lymph node biopsy of breast cancer, and the combination of rituximab and indocyanine green The preparation method of docyanine green combination has no detailed operation steps and specific dosage instructions, and there are currently no reports and studies on the application of sentinel lymph node biopsy

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