临床N0期舌癌颈淋巴结转移相关因素及其外科处理

目的 探讨舌癌隐匿性颈淋巴结转移规律和相关影响因素,以及不同颈淋巴清扫术式对舌癌 的预后影响,为cN0期舌癌患者颈淋巴清扫术术式的选择提供理论依据。方法 收集2002年1月至2010 年8月在广西医科大学附属肿瘤医院头颈外科初治的cN0期舌癌住院患者87例。通过单因素分析隐匿性 颈淋巴结转移与年龄、性别、术前疾病持续时间、原发灶浸润深度、T分期、病理分级的相关性,多 因素分析cN0期舌癌患者的预后影响因素,探讨舌鳞癌颈部转移规律及外科处理方式。结果 单因素 统计分析显示：性别、年龄、术前疾病持续时间对cN0期舌癌患者隐匿性颈淋巴结转移的影响差异无 统计学意义（P＞0.05）,而原发灶浸润深度、T分期、病理分级等因素对颈淋巴结转移的影响差异有 统计学意义（P＜0.05）。多因素Cox风险比例模型分析显示：只有T分期是舌癌cN0期患者的独立预 后因素,不同颈淋巴清扫术对其预后的影响差异无统计学意义。颈择区性淋巴清扫术对肩部的影响更 小（P＜0.05）。结论 原发灶浸润 深度、T分期、病理分级与cN0期舌 癌隐匿性颈淋巴结转移有关,可以作 为预测cN0期舌癌隐匿性颈淋巴结转 移的指标;cN0期舌癌具有较高的隐 匿性颈部淋巴结转移率,以同侧颈部 Ⅰ、Ⅱ、Ⅲ区最为常见,主张行颈择 区淋巴清扫术。     

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.     

舌体鳞癌隐匿性颈淋巴结转移的外科治疗探讨

背景与目的:对于临床颈淋巴结阴性(cN0)的舌癌颈部的处理一直存在争议,本研究旨在探讨cN0舌体鳞癌颈部的合理治疗方案。方法:回顾性分析187例手术前后未行放、化疗的cN0舌体鳞癌初诊患者的临床资料;分析颈部隐匿性淋巴结转移规律和隐匿性淋巴结转移及预后的影响因素,以及颈部不同处理方式的控制情况。结果:隐匿性淋巴结转移率为23.0%,其最常见的位置在同侧颈Ⅱ区,83.0%的隐匿性淋巴结转移分布在同侧颈Ⅰ、Ⅱ、Ⅲ区;病理分级是影响隐匿性淋巴结转移的独立因素;隐匿性淋巴结转移为影响cN0舌癌患者预后的独立因素;肩胛舌骨肌上清扫术的颈部复发率为6.7%。结论:肩胛舌骨肌上颈清扫术是cN0舌体鳞癌患者有效而安全的治疗措施。     

美蓝法定位前哨淋巴结活检在cN0分化型甲状腺癌治疗中的应用

目的探讨前哨淋巴结活检(sentinel lymph node biopsy,SLNB)在cN0分化型甲状腺癌(differentiated thyroid carcinoma,DTC)治疗中的应用及其对颈部淋巴结转移的诊断价值。方法运用美蓝染色法对疑为甲状腺癌的患者行术中SLNB,对证实为甲状腺癌且有SLN转移者行甲状腺癌根治术及改良颈部淋巴结清扫术,术中注意保护喉返神经与甲状旁腺。结果 52例患者中有47例检出前哨淋巴结,SLN检出率为90.4%。21例发现淋巴结转移,其中,Ⅳ区SLN阳性率明显高于Ⅱ、Ⅲ区,且淋巴结转移率与肿块大小有一定相关性。SLNB结果与术后病理对比有2例假阴性。结论 SLNB对cN0分化型甲状腺淋巴转移的预测以及治疗术式的选择具有指导意义,是如今临床中应该推广的方法 。     

舌癌前哨淋巴结微转移检测的初步研究

目的 探索舌癌前哨淋巴结(Sentinel node, SN)微转移检测的适当方法及其预测颈部转移状况的功效.方法 使用γ探头法、术前核素扫描+γ探头法、γ探头法+术中亚甲蓝示踪法进行SN检测,以颈清扫标本的常规病理结果为金标准,评价各方法的功效.石蜡切片病理检查阴性的SN进一步行多层切片+免疫组化检查.结果 全组23例患者(其中初诊的cN0 20例、有手术史的cN0 1例、cN+2例)单用γ探头法,SN检出率为95.6%(22/23),假阴性率为10.5%(2/19),准确率为91%(20/22).5例cN0患者使用术前核素扫描+γ探头法,SN检出率为100%,均为cN0pN0,无假阴性.11例cN0患者使用γ探头探测+染料示踪法检测,全部定位到SN,无假阴性;多层切片+免疫组化检查微转移发现率为6.7%(3/45).结论 舌癌SN活检的初步研究显示出良好的应用前景,但还需进一步研究.术前核素扫描与术中γ探头法、生物染料法相结合是舌癌SN检测的适当方法.连续切片+免疫组化可提高微转移灶的检出率.     

前哨淋巴结活检在乳腺癌治疗中的应用

目的 探讨前哨淋巴结(sentinel lymph node,SLN)是否反映腋窝淋巴结状况.方法 利用锝99m标记的硫胶体(99mTc-硫胶体)进行乳腺癌SLN活检34例,术中用r探测仪进行定位,SLN活检后行改良根治术或保乳手术,对SLN单独送检.结果 34例SLN成功活检33例,成功率97.06%,每例检出SLN 1-3个不等.平均1.26个,SLN活检的灵敏度为94.12%,特异性100%,假阴性率2.93%,假阳性率0,阴性结果预测值为100%,准确性100%.结论 SLN可以反映腋窝淋巴结的转移情况,使大多数患者避免行腋淋巴结清扫.     

舌体鳞癌颈淋巴结转移的规律和治疗策略

背景与目的:目前,对临床颈淋巴结阴性(cN0)的舌癌病例是否需行颈淋巴清扫术治疗仍存争议。本研究目的在于探讨舌体鳞癌的颈部淋巴结转移规律和分区性颈淋巴结清扫术应用于cN0舌癌病例的理论依据和应用原则。方法:回顾性分析1991年至1997年214例手术治疗的舌体鳞癌患者的临床资料;分析cN0pN+(病理检查淋巴结阳性)病例和cN+pN+病例的颈部转移淋巴结分布规律;比较不同分组的远期疗效;Cox回归分析法筛选影响舌体鳞癌患者预后的因素。结果:pN+病例69例,颈淋巴结转移率32.2%,其中同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占22.3%、33.5%、22.3%、4.6%、1.0%;对侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占6.6%、3.6%、3.0%、2.0%、0.5%。pN+组和pN0组5年生存率各为47%、83%(P<0.001);Cox回归分析显示影响舌体鳞癌患者预后的独立因素为T分期、N分期。结论:舌体鳞癌淋巴结转移最常见于同侧颈部Ⅰ、Ⅱ、Ⅲ区;分区性颈淋巴结清扫术对cN0病例既可起治疗的作用,又可用于评价颈部淋巴结转移状况以决定是否行全颈淋巴结清扫术。     

术前核素扫描淋巴显像在乳腺癌前哨淋巴结活检术中的应用

目的:研究术前核素扫描淋巴显相和术中蓝色染料定位活检乳腺癌前哨淋巴结(SLN)的临床应用价值.方法:68例病理诊断乳腺癌,临床腋窝淋巴结阴性患者,术前核素99Tcm-标记硫胶体(99Tcm-sulfur colloid)乳腺区域淋巴系统扫描显相,术中亚甲蓝染色定位活检前哨淋巴结,切除的SLN与清除区域淋巴结送常规病理检查.结果:乳腺癌SLN核素淋巴显相检出率为94.1%(64/68),手术通过蓝色染料定位检出率为91.2%(62/68).假阴性率9.4%(3/32),SLN预测腋窝转移的准确率为96.8%(58/68),敏感性90.6%(29/32),特异性100.0%(32/32).结论:淋巴显相结合蓝色染料法,能准确显示SLN的部位、数目及淋巴引流渠道,术前常规淋巴显像造影可增加前哨淋巴结的预知性,有助于指导内乳区及腋窝外其他淋巴结的放疗决策.     

前哨淋巴结活检术在结直肠癌中的应用研究

目的:探讨结直肠癌中前哨淋巴结定位活检术的适用性。方法:20例结直肠癌患者纳入研究,术前3h经纤维肠镜、肛镜于病灶周围粘膜下注入99mTc标记的右旋糖苷,术中在病灶周围浆膜下注入亚甲蓝,探测仪检测放射性高出背景组织10倍以上或(和)蓝染的淋巴结视为结直肠癌的前哨淋巴结(sentinel lymphnode,SLN),行常规病理检查,分别计算前哨淋巴结诊断结直肠癌区域淋巴结转移状态、假阴性率等,并根据SLN活检结果决定结直肠癌的手术方式。结果:本组结直肠癌SLN的检出成功率为80%(16/20),每例检出1～3个,平均2.4个/例,SLN的转移率为37.5%(18/48);诊断敏感性80%(16/20);诊断准确率83.3%(15/18);假阴性率20%(4/20)。结论:前哨淋巴结活检术适合于结直肠癌,联合示踪法检测结直肠癌前哨淋巴结可判断区域淋巴结的转移状态,并可用于指导结直肠癌淋巴结清扫范围。     

前哨淋巴结活检在早期乳腺癌中的应用价值

目的:探讨活性染料亚甲蓝检测早期乳腺癌前哨淋巴结的可行性及其临床意义.方法:利用亚甲蓝对48例乳腺癌患者进行前哨淋巴结活检(SLNB)并同时行腋窝淋巴结清扫(ALND),根据病理结果进行评价.结果:SLN检出率为95.8% ,SLN对ALN状况预测的敏感度为 90.3%,准确率为95.7%,假阴性为6.5%,假阳性为0.结论:前哨淋巴结活检能比较准确地反映早期乳腺癌的腋窝淋巴结转移情况,可为SLN阴性的患者"保腋窝"提供依据.     

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。     

The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck

BACKGROUND: Sentinel lymph node (SLN) biopsy originally was described as a means of identifying lymph node metastases in malignant melanoma and breast carcinoma. The use of SLN biopsy in patients with oral and oropharyngeal squamous cell carcinoma and clinically N0 necks was investigated to determine whether the pathology of the SLN reflected that of the neck. METHODS: Patients undergoing elective neck dissections for head and neck squamous cell carcinoma accessible to injection were enrolled into our study. Sentinel lymph node biopsy was performed after blue dye and radiocolloid injection. Preoperative lymphoscintigraphy and the perioperative use of a gamma probe identified radioactive SLNs; visualization of blue stained lymphatics identified blue SLNs. A neck dissection completed the surgical procedure, and the pathology of the SLN was compared with that of the remaining neck dissection. RESULTS: Sentinel lymph node biopsy was performed on 40 cases with clinically N0 necks. Twenty were pathologically clear of tumor and 20 contained subclinical metastases. SLNs were found in 17 necks with pathologic disease and contained metastases in 16. The sentinel lymph node was the only lymph node containing tumor in 12 of 16. CONCLUSIONS: The SLN, in head and neck carcinomas accessible to injection without anesthesia, is an accurate reflector of the status of the regional lymph nodes, when found in patients with early tumors. Sentinel lymph nodes may be found in clinically unpredictable sites, and SLN biopsy may aid in identifying the clinically N0 patient with early lymph node disease. If SLNs cannot be located in the neck, an elective lymph node dissection should be considered.     

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making

BACKGROUND: Regional lymph node metastasis is the most reliable predictor of treatment outcomes for patients with squamous cell carcinoma of the oral tongue (SCCOT). A recent American Joint Committee on Cancer staging update of malignant melanoma has incorporated pathologic lymph node staging. The authors hypothesized that pathologic lymph node staging (pN) would be a more reliable predictor of treatment outcomes than clinical lymph node staging (cN). METHODS: The authors retrospectively reviewed 266 patients who received primary surgical treatment for SCCOT, including a neck dissection, from January 1980 to December 1995. Overall and disease-specific survival and disease-free interval were compared with respect to clinical and pathologic lymph node stages. RESULTS: Statistically significant survival differences were identified for both clinical (cN0-cN2) and pathologic lymph node stages (pN0-pN2). However, survival and disease-free interval differences for pathologic lymph node staging reached higher statistical significance (P < 0.0001) than for clinical lymph node staging (P < 0.002). This disparity can be explained by stage migration (i.e., patients with cN0-1 disease have a more advanced lymph node stage at the time of pathologic review compared with patients without cN0-1 disease). The authors found a 34% rate of occult lymph node disease in the cN0 group (19% of occult lymph nodes had extracapsular spread [ECS]). Similarly, 43% of cN1 patients had a higher stage than pN2b disease and 50% had ECS. CONCLUSIONS: Pathologic lymph node staging, based on a staging or therapeutic neck dissection, should be considered for patients treated for SCCOT to identify high-risk patients who may benefit from additional adjuvant therapy. Prospective studies are essential to validate these findings before pathologic lymph node staging is included in standard staging criteria.     

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.     

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.     

肩胛舌骨肌上颈淋巴结清扫术治疗cN0N1期口腔鳞癌对术后患者生活质量的影响

目的 探究行肩胛舌骨肌上颈淋巴结清扫术对cN0 N1期口腔鳞癌患者术后生活质量的影响.方法 纳入口腔鳞癌患者112例,依据手术方法不同将行功能性颈淋巴结清扫术(FND)的62例患者纳入FND组,将行肩胛舌骨肌上颈淋巴结清扫术(SOND)的50例患者纳入SOND组.对比2组术后肩关节功能恢复情况、手术前后生活质量评分、术...