甲状腺癌前哨淋巴结的临床及病理研究

目的 :探讨甲状腺癌前哨淋巴结的检测及其对颈淋巴结转移的预测价值。方法 :用手术中注射蓝染料的方法 ,对 30例甲状腺癌患者进行了手术中前哨淋巴结的临床研究 ,手术中取前哨淋巴结作快速冰冻病理 ,并与手术后常规石蜡切片病理对照 ,观察冰冻病理前哨淋巴结转移与常规病理颈淋巴结转移的相关性 ,及其对颈淋巴结转移的预测价值。手术后以抗角蛋白单抗行一步法免疫组化染色 ,并与常规HE染色对照。结果 :30例甲状腺癌中 2 7例成功的显示了前哨淋巴结 ,成功率 90 %。 2 7例前哨淋巴结平均每例 4枚 ,13例前哨淋巴结阳性的患者 ,其中 2例有前哨淋巴结以外的颈淋巴结转移 ;2例假阴性 ,前哨淋巴结对颈淋巴结转移的总的阳性预测值 86.7%。结论 :前哨淋巴结检测对甲状腺癌的颈淋巴结转移有重要的预测价值。     

甲状腺癌前哨淋巴结的临床及病理研究

目的：探讨甲状腺癌前硝淋巴结的检测及其对颈淋巴结转移的预测价值。方法：用手术中注射蓝染料的方法,对30例甲腺癌患者进行了手术中前哨淋巴结的临床研究,手术中取前哨淋巴结作快速冻冻病理,并与手术后常规石蜡切片病理对照,观察冰冻病理前哨淋巴结转移与常规病理颈淋巴结转移的相关性,及其对颈淋巴结转移的预测价值。手术后以抗角蛋白单抗行一步法免疫组化染色,并与常规HE染色对照,结果：30例甲腺癌中27例成功的显示了前哨淋巴结,成功率90％,27例前哨淋巴结平均每例4枚,13例前哨淋巴结阳性的患者,其中2例有前哨淋巴结以外的颈淋巴结转移;2例假阴性,前哨淋巴结对颈淋巴结转移的总的阳性预测值86．7％,结论：前哨淋巴结检测对甲状腺癌的颈淋巴结转移有重要的预测价值。     

口腔鳞癌术中前哨淋巴结冰冻切片的诊断价值及临床意义

目的：探索N0口腔鳞癌术中颈部前哨淋巴结冰冻切片诊断的准确性及可行性。方法：16例N。口腔鳞癌患者,使用亚甲蓝染色法对前哨淋巴结进行染色识别,并对前哨淋巴结进行术中冰冻病检,同时对常规清扫的淋巴结进行常规石蜡封埋病理检查。结果：16例口腔鳞癌中有13例能检测出前哨淋巴结,共检测出26个淋巴结,平均每例2．16个,检出成功率为81．3％（13／16）,连续冰冻切片发现其中5位患者的8个前哨淋巴结发生癌转移,与术后常规染色病理检查结果一致。结论：临床N0口腔鳞癌术中对前哨淋巴结进行冰冻病理检查能准确反映淋巴结的转移情况,对指导颈淋巴清扫术有一定的临床应用价值。     

甲状腺乳头状癌前哨淋巴结活检的临床意义

目的 探讨甲状腺乳头状癌颈部前哨淋巴结(SLN)活检的准确性及可行性.方法 前瞻性分析23例临床淋巴结阴性(cNO)的甲状腺乳头状癌患者,术前2～5 h在超声引导下瘤体内注入99Tcm-右旋糖酐(99Tcm-DX)74 MBq,术中在肿瘤周围注入亚甲蓝0.2～0.4 ml.采用核素法(淋巴结闪烁显像法+γ探针法)和染料法定位SLN,并行术中冰冻病理检查,与术后颈清扫标本常规病理进行对照.结果 23例甲状腺乳头状癌患者均检测出SLN,检出率达100%(23/23).其中染料法和核素法的检出率分别为87.0%和100%.23例患者中,SLN冰冻阳性12例.1例术中冰冻检测SLN未发现转移癌而术后常规病理发现转移;1例SLN冰冻及病理均未发现转移,但颈清扫标本中非SLN(Ⅵ区)有转移.有21例患者的SLN活检结果与术后颈部淋巴结常规病理结果相符,准确度为91.3%(21/23),阳性预测值为100%(12/12),阴性预测值为81.8%(9/11).结论 SLN活检对预测cNO甲状腺乳头状癌的颈部淋巴结转移和指导临床治疗有重要的意义.     

口腔鳞癌术中前哨淋巴结冰冻切片的诊断价值及临床意义

目的:探索N0口腔鳞癌术中颈部前哨淋巴结冰冻切片诊断的准确性及可行性.方法:16例N0口腔鳞癌患者,使用亚甲蓝染色法对前哨淋巴结进行染色识别,并对前哨淋巴结进行术中冰冻病检,同时对常规清扫的淋巴结进行常规石蜡封埋病理检查.结果:16例口腔鳞癌中有13例能检测出前哨淋巴结,共检测出26个淋巴结,平均每例2.16个,检出成功率为81.3% (13/16),连续冰冻切片发现其中5位患者的8个前哨淋巴结发生癌转移,与术后常规染色病理检查结果一致.结论:临床N0口腔鳞癌术中对前哨淋巴结进行冰冻病理检查能准确反映淋巴结的转移情况,对指导颈淋巴清扫术有一定的临床应用价值.     

颈、甲状腺（041929～041940）

前哨淋巴结检测在头颈部鳞状细胞癌中的应用 颈部囊性肿块的超声诊断与鉴别诊断 磁共振成像和磁共振血管造影响对颈动脉间隙肿瘤诊断价值分析 13例原发性颈段气管腺样囊性癌的手术治疗 原发性不明的颈部淋巴结转移癌的治疗 头颈部恶性纤维组织细胞瘤临床和预后分析 甲状腺微癌62例临床病理分析 甲状腺手术方法的改进     

喉返神经旁淋巴结切除在cNo甲状腺乳头状癌手术中的价值

目的：探讨喉返神经旁淋巴结清除在临床无可触及转移淋巴结甲状腺乳头状癌手术中的意义，以及在选择术式中的价值。方法：复习186例cNo甲状腺乳头状癌的临床病理资料，分析喉返神经旁淋巴结转移同侧颈淋巴结转移的关系。结果：186例cNo甲状腺乳头状癌中喉返神经旁淋巴结转移阳性者占42．5％(79／186)。在有喉返神经旁淋巴结转移的病例中，63．2％同期或术后发生侧颈部淋巴结或远处转移，而喉返神经旁淋巴结阴性病例中仅8例发生转移。结论：喉返神经旁淋巴结转移阳性的cNo甲状腺乳头状癌，其颈部其他区域发生转移的机会明显增加。喉返神经旁淋巴结清除及术中冰冻病理检查可作为cNo甲状腺乳头状癌手术时是否施行选择性颈廓清术的参考依据。     

前哨淋巴结活检对乳腺癌腋窝淋巴结转移状况的预测价值

目的探讨前哨淋巴结活检(SLNB)对乳腺癌腋窝淋巴结转移状况的预测价值。方法以36例体检无腋窝淋巴结转移的乳腺癌患者为研究对象，用美蓝皮下注射染色法定位前哨淋巴结(SLY)，行SLNB，以病理检查结果计算SLNB的成功率及假阴性率、假阳性率、准确性、灵敏度、特异度、阳性符合率、阴性符合率、阳性结果预测值、阴性结果预测值。结果36例患者行SLNB，成功率为97．2％，灵敏度为92．9％。特异度为100％，假阴性率为7．7％，假阳性率为O％，准确率为95．8％，阳性符合率为92．3％；阴性符合率为95．7％，阳性结果预测值为100％，阴性结果预测值为93．9％。结论美蓝皮下注射染色法行SLNB有很高的成功率，SLNB能够准确地预测乳腺癌腋窝淋巴结转移状况。     

胃癌前哨淋巴结及其临床意义

目的 探讨胃癌前哨淋巴结转移规律及其应用价值。方法 1992～1999年经病理明确诊断有1～2个转移淋巴结的胃小弯癌53例,探讨其所在区域,作为该部位胃癌前哨淋巴结。研究其发生的规律及内涵。结果 本组病例转移淋巴结多数出现在第Ⅰ站(86.8％,46/53),其中胃上部癌转移至小弯(NO3)占57.1％(8/14);胃中部癌转移至小弯(NO3)占47.4％(9/19);胃下部癌转移至NO6占35％(7/20)。本组出现淋巴结跳跃转移7例,其中胃下部癌5例。结论 胃癌前哨淋巴结转移状况基本反映了胃癌淋巴转移的规律,在进展期胃癌手术中也应重点清扫,胃癌前哨淋巴结有望成为指导胃癌根治术淋巴清扫范围的标尺。     

前哨淋巴结活检对乳腺癌外科导航的临床分析

目的 探讨前哨淋巴结活检(SLNB)对乳腺癌手术导航的临床价值及可靠性。方法 用染料法(1％亚甲蓝)对30例乳腺癌病人进行腋窝前哨淋巴结(SLN)染色切除。术中冰冻切片，术后石蜡切片，并常规行腋窝淋巴结清除术(ALND)。结果 SLN染色成功率96．7％(29／30)，失败1例。SLN阳性10例，后站淋巴结有癌转移6例(60％)，无癌转移4例（40％)。SLN阴性19例，其中假阴性1例，后站淋巴结均无癌转移。SLNB评价：检出率96．7％、准确率93．3％、敏感度90．9％、假阴性率9．1％、假阳性率0。结论 只要提高技术水平，SLN染料着色和检出率都相对较高，对外科术式选择有实际指导意义。相信SLNB取代传统的ALND已为时不远。     

早期宫颈癌前哨淋巴结活检的临床研究

目的:评价早期宫颈癌前哨淋巴结(SLN)活检的必要性、准确性及临床应用价值.方法:将80例早期宫颈癌患者分别应用生物活性染料亚甲蓝和99Tcm-硫胶体检测SLN,阴性SLN及非SLN行CK19免疫组化检查.结果:80例患者中76例成功检测出227枚SLN,蓝染法、放射性同位素法和联合法检出率分别为80.0%、90.0%...     

头颈部肿瘤前哨淋巴结活检及示踪剂应用

前哨淋巴结活检(SLNB)可通过示踪法确定前哨淋巴结(SLN)并进行活检来评估头颈部肿瘤的区域淋巴结转移而指导颈淋巴结清扫术的进行。常用示踪法有染料识别法、放射性核素示踪法或二者联合应用法,常用染料示踪剂有异硫蓝、专利蓝和美蓝3种,常用核素示踪剂为~(99m)Tc。SLNB在乳腺癌研究中应用较广,近年来已应用于头颈部肿瘤的研究中。     

Sentinel lymph node biopsy as guidance for central neck dissection in patients with papillary thyroid carcinoma

BACKGROUND.

Occult lymph node metastasis of papillary thyroid carcinoma (PTC) can be detected by sentinel lymph node (SLN) biopsy, but studies in larger patient cohorts undergoing complete central neck dissection may be required to assess the diagnostic accuracy of SLN. Therefore, the authors prospectively assessed the usefulness of SLN biopsy for the detection of central lymph node metastasis in patients with differentiated PTC who had no suspicious cervical lymphadenopathy.

METHODS.

After peritumoral injection of methylene blue, SLN biopsy was performed in 50 patients with newly diagnosed PTC who had no palpable or ultrasound (US)‐detected lymph node involvement. After SLN biopsy, all patients underwent total thyroidectomy and central neck dissection. The diagnostic accuracy of intraoperative SLN sampling was calculated by comparison with the final pathologic diagnosis.

RESULTS.

SLNs were identified in 46 of 50 patients (92%); of these, 14 SLNs were positive and 32 SLNs were negative on intraoperative frozen sections. One patient had a positive SLN in the jugular region and subsequently underwent modified radical neck dissection. Final pathologic examination revealed that 18 patients (36%), including 4 who had negative SLNs, had central lymph node metastasis. Thus, the sensitivity, specificity, accuracy, and positive and negative predictive values of SLN biopsy were 77.8%, 100%, 92%, 100%, and 88.9%, respectively. Temporary and permanent hypocalcemia developed in 19 patients and 1 patient, respectively. There were no direct complications of SLN sampling.

CONCLUSIONS.

SLN biopsy in patients with PTC without gross clinical or US lymph node involvement was able to detect occult metastasis with high accuracy and may have the potential to select patients who require central neck dissection. Cancer 2008. © 2008 American Cancer Society.     

乳腺癌前哨淋巴结活检40例报告

目的 :通过对乳腺癌前哨淋巴结 (SLN)活检 ,探讨其对腋淋巴结转移情况预测的准确性。方法 :采用亚甲蓝染料法对 4 0例乳腺癌行腋窝蓝染淋巴结活检 ,后行常规腋窝淋巴结清除 (ALND) ,两标本均送病理检查。结果 :全组 4 0例患者检出SLN 38例 ,2例未找到SLN ,检出率为 95 % ( 38/ 4 0 ) ,有 8例SLN为阳性 ,1例SLN为假阴性 ,腋窝淋巴结 (ALN)有 9例转移 ,SLN与ALN病理检查完全符合者 37例 ,准确率为 92 5 % ( 37/ 38) ;灵敏度为 88 9% ( 8/ 9) ;假阴性率为 11 1% ( 1/ 9)。结论 :亚甲蓝染色法能准确地鉴别SLN及预测乳腺癌腋窝淋巴结状态     

纳米碳标记前哨淋巴结在早期宫颈癌诊疗中的价值研究

目的:探讨纳米碳标记前哨淋巴结活检（carbon nanoparticle labeled sentinel lymph node biopsy,SLNB）对早期宫颈癌患者诊疗的应用价值。方法:48例早期宫颈癌患者于宫颈3点、9点分别注射稀释后的纳米碳1 mL,腹腔镜下获取SLN后行广泛全子宫切除+盆腔淋巴结清扫术,切除的SLN及非前哨淋巴结行病理检查。结果:48例患者均检出SLN,平均每例患者检出(3±1.5)枚,显影率为100%,其中闭孔淋巴引流区为检出SLN最多的部位,其次为髂内、髂外和髂总动脉淋巴引流区。术后病理显示4例患者淋巴结阳性,阳性淋巴结共12枚,SLN 10枚,非SLN 2枚,而这4例淋巴结转移患者均被SLNB成功检出。SLNB假阳性率和假阴性率均为0,敏感性为100%（4/4）,准确性为100%（48/48）,阴性预测值为100%（44/44）。结论:纳米碳标记的SLNB可以准确预测早期宫颈癌患者盆腔淋巴结的转移情况。     

Sentinel lymph-node biopsy in head and neck cancer

The aim of the study was to assess the diagnostic value of the sentinel node method in patients suffering from squamous cell carcinoma of the upper aerodigestive tract. In 50 patients with oral, pharyngeal or laryngeal carcinomas staged N0 up to 50 MBq technetium-99m colloid were injected peritumorally. Sentinel nodes were localised using a gamma-probe in the setting of an elective neck dissection. Pathological findings of sentinel nodes and corresponding neck specimens were compared. In 46 patients sentinel nodes were detected. Of these 34 patients were free of metastatic disease in the sentinel nodes and in the neck specimens. In 12 patients clinically occult metastases were found in the sentinel nodes. Three metastases were detected only after additional sectioning of the sentinel nodes. In four patients, a sentinel lymph node could not be localised. Our results support the sentinel node concept in head and neck cancer and a definition of the sentinel nodes as the three nodes with the highest activity. Careful clinical staging of the neck and thorough pathological evaluation of the sentinel nodes are necessary to avoid false-negative results.     

Second echelon node predicts metastatic involvement of additional axillary nodes following sentinel node biopsy in early breast cancer

BACKGROUND: In many patients with early breast cancer, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients may not benefit from completion axillary lymph node dissection (CALND). AIMS: This pilot study evaluates the status of 2nd echelon (station) lymph nodes in the axilla as a predictor of additional positive nodes in the axilla in the presence of sentinel node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40 breast cancer patients. MATERIALS AND METHODS: Forty patients with invasive breast cancer underwent SLN biopsy followed by 2nd echelon lymph node biopsy in the same sitting. SLN mapping was performed using a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs (Station I) were defined as blue and/or hot nodes. These nodes were then injected with 0.1 ml of blue dye using a fine needle and their efferent lymphatic was traced to identify the Station II nodes. Then a complete ALND was performed. All the specimens were sent separately for histopathological evaluation. RESULTS: SLNs (Station I nodes) were successfully identified in 98% (39/40) patients. Of the 17 patients with a positive SLN, 8 (47%) patients had no further positive nodes in the axilla, 9 (53%) patients had additional metastasis in nonsentinel lymph nodes upon CALND. Station II nodes were identified in 76% (13/17) patients with a positive SLN. Station II nodes accurately predicted the status of the remaining axilla in 92% patients (12/13). STATISTICAL ANALYSIS: We calculated the Sensitivity, Negative predictive value, Positive predictive value, False negative rate and Identification rate. CONCLUSION: Station II nodes may predict metastatic involvement of additional nodes in the axilla.     

Ability of lymphoscintigraphy to direct sentinel node biopsy in the clinically NO check for patients with head and neck squamous cell carcinoma; a prospective study (preliminary results)

Detection of metastasis involvement of lymph nodes is essential for management and prognostic evaluation in most cancer cases. The success of lymphatic mapping depends on identifying the sentinel lymph node(s) draining the primary tumour. In this preliminary study we prospectively evaluated the feasibility of sentinel node radio localisation in head and neck squamous cell carcinoma N0 stage to gain insight as to whether the sentinel lymph node (SLN) could be prognostic of regional metastasis disease or not. In 14 patients with squamous cell carcinoma of the head and neck region preoperative lymphoscintigraphy (LSG) mapping of the tumour was performed after subcutaneous injection of 22 to 30 MBq of Tc99m-labelled sulfur colloid. SLN was detected and localised by LSG in all patients with a gamma camera and a hand-held gamma probe. All the patients underwent surgery SLN and cervical nodes dissection. Six SLNs for five patients revealed occult metastasis disease. No skip metastasis were found in the 9 necks with negative SLN analysis. The results of this preliminary study are encouraging. They showed that SLN in squamous cell carcinoma of the head and neck N0 is accurately feasible and could predict the presence of occult metastasis. Nevertheless, more data are needed to validate these results.     

乳腺癌前哨淋巴结活检的临床意义(附30例报告)

目的　探讨开展乳腺癌前哨淋巴结活检 (sentinellymphnodebiopsy ,SLNB)的必要性、可行性、准确性及临床应用价值。方法　术前在乳腺肿瘤下方注射 37MBq放射性胶体99mTc DX ,同时运用核素淋巴显像和γ计数器探测仪探测两种检测方法 ,识别出放射性同位素浓聚的前哨淋巴结(sentinellymphnode ,SLN) ,并用皮肤墨水在相应的皮肤上做出标记。术中根据体表标记切除SLN ,后行腋窝淋巴结解剖 (axilarylymphnodedissection ,ALND) ,两标本同时送病理检查 ,了解其符合率 ,并评价SLNB的可行性。结果　 30例均进行了SLN识别定位 ,活检后经病理检查有 2例错误。 1例未取到SLN ,故SLN的检出率为 96 .7% ;1例SLN病理呈假阴性。按目前国外SLNB的评价标准 ,本组SLNB的敏感度为 88.9% ,准确性为 93.3% ,假阳性率为 0 ,假阴性率为 11.1%。结论　乳腺癌SLNB目前在国内外仍处于研究阶段 ,随着研究的扩大与深入将可能取代常规的ALND。