乳腺癌前哨淋巴结活检对腋窝淋巴结转移的预警价值研究

目的探讨乳腺癌前哨淋巴结(sentinel lymph node,SLN)预警腋窝淋巴结转移的价值. 方法对56例乳腺癌行亚甲蓝前哨淋巴结定位、活检和腋窝淋巴结清扫术,标本常规行HE染色、免疫组化病理检查. 结果 SLN成功检出52例(52/56,92.8%),常规病理检查证实SLN转移22例;SLN无转移,但非SLN发现转移者1例,假阴性率为4.3%(1/23).常规病理检查无转移的29例患者,免疫组化检测发现1例CK-19( )、EMA( ),另1例CK-19( ),CEA( ),而所属非前哨淋巴结无肿瘤转移. 结论乳腺癌亚甲蓝前哨淋巴结定位、活检可以预示腋窝淋巴结转移.     

胃癌前哨淋巴结术中定位和病理学检查

目的探讨肿瘤前哨淋巴结(SLN)活检技术在胃癌诊疗中应用的可行性。方法将38例胃癌患者,按肿瘤浸润深度分组,用术中注射美蓝的方法定位前哨淋巴结,用细胞角蛋白(CK-19)免疫组织化学染色判断淋巴结转移情况。结果38例患者全部检出SLN(100%)。出现淋巴结转移的有18例,其中SLN出现转移的有15例。SLN预测淋巴结癌转移的敏感性、假阴性率和准确率分别为83.3%、16.7%和92.1%;胃癌T1组无SLN假阴性者,准确率100%;T2组有1例假阴性者,准确率94.1%;T3组假阴性2例,准确率6/8例。结论采用肿瘤周围注射亚甲蓝的方法术中定位淋巴结为可行的SLN术中定位方法。     

腹腔镜下前哨淋巴结检测在早期宫颈癌中的应用

目的探讨早期宫颈癌腹腔镜下前哨淋巴结（Sentinel lymph node,SLN）检测的可行性及前哨淋巴结活检预测盆腔淋巴结转移状况的准确性,评价SLN活检在早期宫颈癌中的应用价值。方法选择诊断明确的早期宫颈癌患者26例,采用腹腔镜下广泛子宫切除术和盆腔淋巴结清扫术,术中从宫颈分4点注射1%亚甲蓝染料4ml行淋巴绘图,腹腔镜下识别和取蓝染淋巴结活检。蓝染淋巴结和手术的其他标本分别送病理检查,常规石蜡包埋切片、HE染色,以手术后所有切除的盆腔淋巴结常规HE染色病理检查结果为诊断金标准,观察SLN活检对预测盆腔淋巴结有无肿瘤转移的准确性、假阴性率等及SLN分布情况。结果26例宫颈癌中,23例成功检测出SLN,检出率为88.5%（23/26）。共检出SLN51枚,其中1个SLN者6例,2个SLN者9例,3个SLN者6例,4个SLN者1例,5个SLN者1例。双侧分布者占65.2%（15/23）。26例中,5例（19.2%）盆腔淋巴结有转移。23例SLN成功识别的患者中,3例（6枚）SLN存在转移。SLN转移且盆腔淋巴结有转移者2例,SLN是盆腔淋巴结唯一转移者1例,SLN无转移而盆腔淋巴结有转移者1例。SLN活检预测盆腔淋巴结的准确性为95.7%（22/23）,灵敏度为75%（3/4）,特异度为100%（19/19）,阴性预测值为95%（19/20）,SLN与盆腔淋巴结的转移有极好的一致性（κ=0.832）。结论采用腹腔镜技术可以较准确地检测出SLN,可以用于早期宫颈癌SLN活检;SLN能较准确地反映区域淋巴结的转移状况。     

乳腺癌前哨淋巴结检测的临床研究

目的通过前哨淋巴结(sentinel lymph node,SLN)活检,了解前哨淋巴结是否能反映乳腺癌腋窝淋巴结转移情况,从而决定是否行腋窝淋巴结清扫(axillary lymph node dissection,ALND). 方法 47例T1、T2、T3临床检查腋窝淋巴结无肿大的乳腺癌患者,术前30 min于乳腺肿块周围腺体注射蓝色染料,术中取蓝染的SLN病理检查,术后将病理检查结果与腋窝淋巴结转移情况进行比较分析. 结果 47例中5例未见淋巴结及淋巴管蓝染,其余42例找到腋窝淋巴结608个,阳性18例168个,阴性24例440个;SLN共78个,阳性16例29个,阴性26例49个.SLN的检出率89.4%,准确性95.2% ,特异性100%,敏感性88.9%,假阴性率11.1%,假阳性率0. 结论 SLN活检反应腋窝淋巴结的肿瘤转移状况,可以用于术中确定是否行ALND.     

前哨淋巴结活检在乳腺癌中的临床应用

目的 探讨术中前哨淋巴结（sentinel lymph node,SLN）定位和活检（SLNB）对预测乳腺癌腋窝淋巴结（axillary lymph node,ALN）转移的准确性.方法 对48例乳腺癌患者术前10min用亚甲蓝注射液4ml注射到肿瘤周围或活检腔的正常乳腺组织,进行SLN定位和活检,然后行乳腺癌改良根治术.结果 SLNB的检出成功率为95.8%,准确率为97.8%,假阴性率3.0%,假阳性率为0.结论 用亚甲蓝作SLN定位进行SLNB能准确预测乳腺癌ALN转移状态.     

99Tcm-硫化铼胶体在乳腺癌前哨淋巴结活检中的应用

目的：探讨99Tcm-硫化铼胶体在乳腺癌前哨淋巴结（SLN）活检中的应用价值。 方法：30例T1~T2期乳腺恶性肿瘤患者入选,术前15~24 h乳晕下注射99Tcm-硫化铼,使用SPECT/CT进行SLN淋巴显像,定位;术中用γ探测仪寻找SLN,行SLN活检后,常规行乳癌手术;术后对SLN活检和腋窝淋巴结（ALN）清扫的病理结果进行比较分析。 结果：30例共有29例检到SLN,共检出SLN 31枚,检出率,准确率分别为97.67%,100%;SLN状态与腋淋巴结转移的符合率为100%,无假阳性及假阴性情况出现。 结论：99Tcm-硫化铼用于乳腺癌SLN活检是一种较理想的核素示踪剂。     

在胃癌中应用~(99m)Tc锡胶体作淋巴定位图和前哨淋巴结活检

胃癌采用D2 根治术已列为常规术式。鉴于广泛淋巴结清扫术带来一定的并发症 ,Miwa提出在早期病例中 ,凡无区域淋巴结转移者主张作有限的淋巴结清扫术即D1手术 ;如伴有区域淋巴结转移者 ,则至少作D2 淋巴结清扫术 ,可试用淋巴结定位图和前哨淋巴结活检 (SLN)的结果来确定淋巴结的清扫范围。从理论上讲 ,引流肿瘤的第一个淋巴结应该是淋巴结转移的第一个位置。为了确定SLN活检以判断胃癌淋巴结状态的可行性 ,作者对 46例胃癌病例进行了SLN活检 ,检查其正确法。方法　 46例的平均年龄为 5 3 .2± 1 2 .1岁。肿瘤大小平均 2 .3cm( 0 .5～ …     

γ探测仪在乳腺癌前哨淋巴结定位活检中的应用

目的:探讨γ探测仪在临床腋窝淋巴结阴性乳腺癌前哨淋巴结定位活检术(SLNB)中的临床应用价值.方法:利用99m锝-右旋糖酐(99mTc-DX)作为前哨淋巴结(SLN)示踪剂,应用γ探测仪定位对29例临床腋窝淋巴结阴性乳腺癌病人实施SLNB,随后进行常规腋窝淋巴清扫术,分析SLNB对腋窝淋巴结转移状态的预测价值.结果:本组SLN转移率为41.67%,非SLN转移率仅为22.54%,两者有明显差异(P＜0.001).在19例常规病理SLN阴性病人中,连续切片发现2例SLN微转移.在12例SLN癌转移中,5例(41.66%)SLN为惟一的转移部位.有1例SLN阴性病人"跳跃转移".本组SLN的敏感性为92.31%,特异性为94.12%,假阴性为7.69%,准确率达96.55%.结论:SLN能准确反映早期乳腺癌腋窝淋巴结转移状态,连续切片能提高SLNB的准确性.     

内镜黏膜下剥离术联合腹腔镜前哨淋巴结活检术治疗早期胃癌26例分析

目的 探讨内镜黏膜下剥离术（ESD）联合腹腔镜前哨淋巴结活检术治疗早期胃癌的可行性和临床疗效。方法 回顾性分析2009年3月至2013年8月期间在江南大学附属医院行ESD联合腹腔镜前哨淋巴结活检术治疗的26例早期胃癌患者的临床资料。对这些患者先行腹腔镜前哨淋巴结活检术,如冰冻病理学检查结果提示有淋巴结转移,则行腹腔镜下胃癌D2根治术;如提示无淋巴结转移,则行ESD。结果 本组26例患者共检出SLN 95枚,（3.7±1.4）枚/例,（1～6枚/例）;有2例患者因SLN阳性而行腹腔镜辅助远端胃癌根治术,24例患者行ESD。26例患者术后随访时间5～46个月,中位随访时间22个月。ESD术后无病生存率（DFS）为91.7% （22/24）,局部复发率为4.2% （1/24）;总体DFS为96.2% （25/26）。结论 ESD治疗早期胃癌是安全、可行的,联合腹腔镜胃癌前哨淋巴结活检术更符合肿瘤根治原则。     

在胃癌中应用^99mTc锡胶体作淋巴定位图和前哨淋巴结活检

胃癌采用D2根治术已列为常规术式。鉴于广泛淋巴结清扫术带来一定的并发症，Miwa提出在早期病例中，凡无区域淋巴结转移者主张作有限的淋巴结清扫术即D2手术；如伴有区域淋巴结转移者，则至少作D2淋巴结清扫术，可试用淋巴结定位图和前哨淋巴结活检(SLN)的结果来确定淋巴结的清扫范围。从理论上讲，引流肿瘤的第一个淋巴结应该是淋巴结转移的第一个位置。为了确定SLN活检以判断胃癌淋巴结状态的可行性，作者对46例胃癌病例进行了SLN活检，检查其正确法。     

专利蓝和放射物联合示踪检测胃癌前哨淋巴结及其临床意义

目的 探讨胃癌中前哨淋巴结(SLN)概念的适用性,评估前哨淋巴结活检预测胃癌区域淋巴结转移状态的价值及其指导胃癌淋巴结清扫范围的临床意义。方法26例胃癌患者,术前经胃镜于病灶周围黏膜下注入^99mTc标记的硫胶体,术中于病灶周围浆膜下直接注入专利蓝,将γ探测仪检测放射活性高出背景组织10倍以上或(和)蓝染的淋巴结视为胃癌前哨淋巴结,行常规病理检查和细胞角蛋白免疫组化染色,分别计算前哨淋巴结诊断胃癌淋巴结转移状态的准确性、敏感性、阴性预测值和假阴性率,并根据前哨淋巴结活检结果决定胃癌的手术方式。结果胃癌前哨淋巴结的检出成功率为96％(25／26),每例检出1～6个,平均3．2个／例。胃癌前哨淋巴结仅限于N1分布的占50％(13／26),仅限于N2或N3分布的占12％(3／26)。SLN诊断胃癌周围淋巴结转移状态的准确性为96％,敏感性为94％,阴性预测值为7／8,假阴性率为6％。对前哨淋巴结的彻底病理检查使2／7胃癌病例的淋巴结病理分期得到上调。结论前哨淋巴结概念适合于胃癌;联合示踪法胃癌前哨淋巴结活检可准确预测胃癌周围淋巴结的转移状态,并可能用于指导胃癌的淋巴结清扫范围。     

The effect of changing gamma count threshold on sentinel lymph node accuracy

PURPOSE: Sentinel lymph node (SLN) biopsy has been increasingly accepted in many centers as an alternative to axillary lymph node dissection in the nodal staging of breast cancer. The goal of SLN biopsy is to accurately stage the axilla while minimizing postoperative morbidity. Theoretically, the continuing search for SLNs disrupts additional lymphatics and impacts on operative time. The gamma count threshold is a predefined threshold percentage of the ex vivo count of the "hottest" SLN, which when applied to each individually excised lymph node determines whether a given lymph node is the SLN or a non-SLN. The higher the threshold percentage, the less the number of lymph nodes will meet the criteria of being an SLN. This study examines the hypothesis that changing the gamma count threshold from 10% to 50% will not significantly affect accuracy or the false-negative rate. METHODS: We retrospectively reviewed the charts of patients who underwent SLN biopsy with or without completion axillary lymph node dissection from March 1995 to January 2001 at Walter Reed Army Medical Center. Data were collected on gamma counts for each SLN and histopathology of each SLN. For each SLN ex vivo gamma count, percentage of the ex vivo gamma count of the "hottest" SLN was calculated. RESULTS: The SLN identification success rate was 94% (163 out of 174 patients). On average, 2.07 SLNs were removed per patient and 58% of patients had more than 1 SLN removed (94 out of 163 patients). Only 10% had 4 or more SLNs removed (17 out of 163 patients). Sentinel lymph node metastasis was found in 21% of patients (35 of 163 patients). Of these 35 patients with positive SLNs, 8 patients had a negative "hottest" SLN when a less radioactive SLN was positive for metastasis. Changing the gamma count threshold from 10% to 50% lowers the extrapolated accuracy from 98% to 95% and increases the extrapolated false-negative rate from 8% to 21%. CONCLUSIONS: The accuracy and false-negative rate of SLN biopsy varies based on the lower limit gamma threshold. Maintaining our 10% gamma count threshold results in acceptable accuracy and false-negative rates comparable to reported literature.     

Sentinel lymph node biopsy in breast cancer: an analysis of the maximum number of nodes requiring excision

Sentinel lymph node biopsy (SNB) is now the standard of care in assessment of patients with clinically staged T1-2, N0 breast cancers. This study investigates whether there is a maximum number of sentinel lymph nodes (SLN) that need to be excised without compromising the false-negative (FN) rate of this procedure. Data were prospectively collected for 319 patients undergoing SNB between February 2001 and December 2006 at our institution. This data were analysed, both in terms of the order of SLN retrieval and relative isotope counts of the SLNs, in order to determine the maximum number of SLNs that need to be retrieved without increasing the FN rate. Furthermore, we investigated the relationship between SLN blue dye concentration and the presence of SLN metastases. The SLN identification rate was 97% with no false-negative cases amongst patients undergoing simultaneous axillary clearance historically during technique validation. In patients with SLN metastases, excision of the first 4 SLNs encountered results in the identification of a metastatic SLN in all cases. Although the majority (86%) of SNB metastases are in the hottest node, the SLN containing the metastasis is in the first 4 hottest nodes in 99% of patients with nodal metastases. The remaining 1% of SLN metastases were identified by blue dye. There was no statistically significant association between the SLN blue dye concentration and the presence of SLN metastases. A policy to remove a maximum of four blue and/or hot SLNs along with any palpably abnormal lymph nodes does not result in an increased false-negative rate of detection of SLN metastases.     

纳米碳对乳腺癌腋窝前哨淋巴结活检的应用价值

目的：探讨纳米碳混悬液注射对乳腺癌前哨淋巴结示踪的效果。 方法：对36例乳腺癌患者,术前30 min于乳晕周围分4点皮下均匀注射纳米碳混悬液,找到腋窝黑染淋巴结确定为前哨淋巴结,然后行乳腺癌改良根治或保乳手术。 结果：全组成功检查前哨淋巴结34例,检出率为94.4%（34/36）;准确率为91.6%（33/36）,灵敏度为93.3 %（14/15）;假阴性率6.6%（1/15）,假阳性率为0。 结论：纳米碳混悬液作为示踪剂能准确反映腋窝淋巴结转移状态,对指导乳腺癌根治性切除术范围具有临床应用价值。     

Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma

BACKGROUND: The aim of this study was to determine the feasibility and accuracy of sentinel lymph node (SLN) biopsy for oesophageal adenocarcinoma. METHODS: Fifty-seven patients with adenocarcinoma of the lower oesophagus (n = 40) or gastric cardia (n = 17) underwent endoscopic peritumoral injection of (99m)Tc-radiolabelled nanocolloid before en bloc resection with extended lymphadenectomy. SLNs were identified during surgery using a handheld gamma probe and the pattern of radioactive uptake was quantified after operation. All 1667 resected lymph nodes were examined immunohistochemically for micrometastases. RESULTS: SLNs were identified in all 57 patients. They contained metastases (n = 32) or micrometastases (n = 3) in 35 of 37 node-positive patients and there were two false-negative studies. The overall accuracy of SLN biopsy was 96 per cent and SLNs were more likely to contain tumour than other lymph nodes (P < 0.001). Tumour-infiltrated nodal stations had a higher proportion of radioactive uptake (P < 0.001). Lower oesophageal tumours had a greater proportion of SLNs (P = 0.018), radioactive uptake (P < 0.001) and malignant nodes (P = 0.004) in the mediastinum than gastric cardia tumours. CONCLUSION: The sentinel node concept is applicable to oesophageal adenocarcinoma and could be used to tailor the extent of lymphadenectomy. There is a close relationship between patterns of radioactive uptake and lymphatic tumour dissemination, which differ for lower oesophageal and gastric cardia tumours.     

前哨淋巴结活检在结直肠癌根治术中的应用研究

目的探讨前哨淋巴结活检（SLNB）在结直肠癌根治术中临床应用的可行性及其价值。方法应用美蓝对67例结直肠癌患者行前哨淋巴结（SLN）定位活检,分体内、体外组,采用HE染色病理检查法、CK-20免疫组化染色（SP法）检测SLN中转移癌。结果共检出淋巴结660枚,其中SLN130枚,检出率19．7％。腹腔镜结直肠癌根治术和开腹结直肠癌根治术对SLN的检出差异无统计学意义（P=0．742）;体内、体外两种SLN的标记方法差异无统计学意义（P=0．564）;SP法检测SLN癌转移的敏感性明显高于HE染色,而假阴性率明显低于后者;肿瘤细胞在SLN的转移率明显高于区域淋巴结的转移率（P〈0．01）。结论结直肠癌根治术中体内、体外SLN定位方法均可以获得成功,均具有切实的可行性,与手术方式无关,并能够预测区域淋巴结的转移状况;通过SP法检查有助于明确结直肠癌的病理分期,有利于判断预后和个体化治疗方案的制定。     

Preoperative lymphoscintigraphy for breast cancer does not improve the ability to identify axillary sentinel lymph nodes

OBJECTIVE: To evaluate the role of preoperative lymphoscintigraphy in sentinel lymph node (SLN) biopsy for breast cancer. SUMMARY BACKGROUND DATA: Numerous studies have demonstrated that SLN biopsy can be used to stage axillary lymph nodes for breast cancer. SLN biopsy is performed using injection of radioactive colloid, blue dye, or both. When radioactive colloid is used, a preoperative lymphoscintigram (nuclear medicine scan) is often obtained to ease SLN identification. Whether a preoperative lymphoscintigram adds diagnostic accuracy to offset the additional time and cost required is not clear. METHODS: After informed consent was obtained, 805 patients were enrolled in the University of Louisville Breast Cancer Sentinel Lymph Node Study, a multiinstitutional study involving 99 surgeons. Patients with clinical stage T1-2, N0 breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Preoperative lymphoscintigraphy was performed at the discretion of the individual surgeon. Biopsy of nonaxillary SLNs was not required in the protocol. Chi-square analysis and analysis of variance were used for statistical comparison. RESULTS: Radioactive colloid injection was performed in 588 patients. In 560, peritumoral injection of isosulfan blue dye was also performed. A preoperative lymphoscintigram was obtained in 348 of the 588 patients (59%). The SLN was identified in 221 of 240 patients (92.1%) who did not undergo a preoperative lymphoscintigram, with a false-negative rate of 1.6%. In the 348 patients who underwent a preoperative lymphoscintigram, the SLN was identified in 310 (89.1%), with a false-negative rate of 8.7%. A mean of 2.2 and 2. 0 SLNs per patient were removed in the groups without and with a preoperative lymphoscintigram, respectively. There was no statistically significant difference in the SLN identification rate, false-negative rate, or number of SLNs removed when a preoperative lymphoscintigram was obtained. CONCLUSIONS: Preoperative lymphoscintigraphy does not improve the ability to identify axillary SLN during surgery, nor does it decrease the false-negative rate. Routine preoperative lymphoscintigraphy is not necessary for the identification of axillary SLNs in breast cancer.     

Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer

OBJECTIVE: The aim of this study was to determine the feasibility of sentinel lymph node (SLN) biopsy in patients with gastric cancer for the assessment of regional lymph node status. SUMMARY BACKGROUND DATA: SLN is the first draining node from the primary lesion, and it is the first site of lymph node metastasis in malignancy. SLN mapping and biopsy are of great significance in the determination of the extent of lymphadenectomy, allowing patients with gastric cancer to have a better quality of life without jeopardizing survival. METHODS: The SLN biopsy was performed in 46 consecutive patients having gastric cancer with a preoperative imaging stage of T1/T2, N0, or M0. Three hours prior to each operation, Tc tin colloid (2.0 mL, 1.0 mCi) was endoscopically injected into the gastric submucosa around the primary tumor. Subsequently, serial lymphoscintigraphy was performed using a dual-head gamma camera. After the SLN biopsy had been performed using a gamma probe, all patients underwent radical gastrectomy (D2 or D2+alpha). The SLN was cut and immediately frozen-sectioned. A paraffin block was then produced for permanent hematoxylin-eosin staining and immunohistochemistry (IHC). RESULTS: SLNs were successfully identified in 43 of 46 patients (success rate, 93.5%). On average, 2 (range, 1-8) SLNs were identified per patient. The positive predictive value, negative predictive value, sensitivity, and specificity of SLN biopsy were 100% (11 of 11), 93.8% (30 of 32), 84.6% (11 of 13), and 100% (30 of 30), respectively. SLNs were located at the level I lymph nodes in 38 (88.4%), the level I+II nodes in 2 (4.7%), and the level II nodes in 3 (7.0%). No micrometastases of SLNs was found on IHC for cytokeratin. CONCLUSIONS: SLN biopsy using a radioisotope in patients with gastric cancer is a technically feasible and accurate technique, and it is a minimally invasive approach in the assessment of patient nodal status.