头颈部癌前哨淋巴结的临床研究

目的 探讨头颈部肿瘤前哨淋巴结的检测及其对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51例未经治疗的头颈部癌颈淋巴结NO的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和常规病理颈淋巴结转移的相关性及其对颈淋巴结转移 癌的预测值。结果 51例中48例成功的显示了前哨淋巴结,成功率94．1％,前哨淋巴结平均每例每侧2．5枚。11例前哨啉巴结阳性,其中2例有前哨淋巴结以外的颈淋巴结转移,2例为假阴性。前哨淋巴结对颈淋巴结转移的总阳性预测值为85％。结论 前哨淋巴结检测对头颈部癌的淋巴结转移有重要的预测价值。     

Sentinel lymph node biopsy for cutaneous head and neck malignancies

Sentinel lymph node biopsy (SLNB) is a procedure that can provide critical information regarding pathologic lymph node status and accurate regional staging. This is very important for developing treatment plans and providing prognostic guidance for cutaneous malignancies. The head and neck (HN) region is unique from other body sites due to its complex lymphatic drainage pathways, multiple lymph node basins, proximity of important cranial nerves and potential for contralateral or bilateral drainage. These unique aspects of the HN previously created some uncertainty about the use of SLNB in the HN. This review will discuss the current reliable status of HN SLNB and provide a guide for its current application in cutaneous malignancy of the HN.     

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^99mTc。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。     

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 is accurate and prognostic in head and neck melanoma

BACKGROUND:

Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single‐institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites.

METHODS:

A prospectively collected database was queried for cutaneous head and neck melanoma patients who underwent SLNB at the University of Michigan between 1997 and 2007. Primary endpoints included SLNB result, time to recurrence, site of recurrence, and date and cause of death. Multivariate models were constructed for analyses.

RESULTS:

Three hundred fifty‐three patients were identified. A sentinel lymph node was identified in 352 of 353 patients (99.7%). Sixty‐nine of the 353 (19.6%) patients had a positive SLNB. Seventeen of 68 patients (25%) undergoing completion lymphadenectomy after a positive SLNB result had at least 1 additional positive nonsentinel lymph node. Patients with local control and a negative SLNB failed regionally in 4.2% of cases. Multivariate analysis revealed positive SLNB status to be the most prognostic clinicopathologic predictor of poor outcome; hazard ratio was 4.23 for SLNB status and recurrence‐free survival (P < .0001) and 3.33 for overall survival (P < .0001).

CONCLUSIONS:

SLNB is accurate and its results are of prognostic importance for head and neck melanoma patients. Cancer 2012;. © 2011 American Cancer Society.     

Sentinel lymph node biopsy in breast cancer

The clinical management of breast cancer has improved tremendously in the last 2 decades. Sentinel lymph node biopsy (SNB) allows conservation of the axillary lymph nodes in most patients who have breast cancer. Furthermore, it allows identification of occult nodal disease after step sectioning and more detailed staging. Although large breast tumors, multicentric disease, recurrent cancers, and use of neoadjuvant therapy were previously considered contraindications to SNB, a large body of evidence is accumulating to support its use in these cases. The prognostic significance of micrometastases and isolated tumor cells needs clarification in prospective, randomized trials.     

Sentinel lymph node biopsy in oral cancer

Management of the cervical lymph nodes is one of the most important factors in controlling head and neck carcinoma. The clinical treatment strategy for managing the N0 neck in oral cancer is still under debate. Recently, the accuracy and feasibility of sentinel lymph node biopsy (SNB) have been investigated in many studies. An application of the technique to the area of oral cancer was therefore obvious. We reported the technique and accuracy of SNB in our center, and have reviewed the preliminary reports indicating that sentinel node identification is technically feasible in oral and pharynx cancer stages T1 and T2 with clinical N0. However, a multi-institutional trial is needed to determine whether SNB should become a standard procedure.     

头颈部肿瘤的前哨淋巴结活检

cN0头颈部肿瘤的处理还存在争议,近几年国外学者将前哨淋巴结(SLN)活检技术引入cN0头颈部肿瘤的治疗中,初步研究表明是可行的.现介绍该技术的检测方法、临床应用、意义及存在的问题.     

头颈部肿瘤的前哨淋巴结活检

cN0头颈部肿瘤的处理还存在争议,近几年国外学者将前哨淋巴结（SLN）活检技术引入cN0头颈部肿瘤的治疗中,初步研究表明是可行的.现介绍该技术的检测方法、临床应用、意义及存在的问题.     

胃癌前哨淋巴结活检

近年来前哨淋巴结活检(SLNB)技术已经成为胃癌研究的热点,将极大推动胃癌个体化淋巴结清扫术的发展.SLNB对指导胃癌淋巴结的清扫范围有肯定价值,在胃癌的外科治疗中具有良好的应用前景.     

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.     

Sentinel lymph node biopsy in breast cancer.

The concept of sentinel lymph node (SLN) biopsy in breast cancer patients is simple, attractive and rapidly emerging as a new standard of care. Several aspects of the technique of lymphatic mapping, case selection, pathologic analysis and the finding of micrometastases, and the accuracy of the technique are important subjects of study and debate in the literature and will be discussed in this review. High identification rates can be attained by the use of both radioguided and blue dye lymphatic mapping. Intradermal injection of tracers has reported to be successful, suggesting that dermal and parenchymal lymphatics drain to the same SLN. Extra axillary drainage is only seen after peri- or intratumoural injection. SLN biopsy is most widely used for both palpable and non-palpable T1 and T2 tumours, and limited experience exists for other indications. Accuracy is high only in experienced hands. The impact of failure of the procedure on regional disease control and survival will be assessed in a trial of the NSABP (National Adjuvant Breast and Bowel Project). The influence of a positive SLN biopsy with and without axillary dissection on survival and local control will be studied in trials of the BASO (British Association of Surgical Oncology), ACOSOG (American College of Surgeons Oncology Group) and EORTC (European Organisation for Research and Treatment of Cancer). These phase III trials and related studies on the importance of micrometastases in the SLN will give new insights in the safety of the SLN procedure and in the importance of treatment of regional lymph nodes in relation to local disease control and survival.     

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.     

前哨淋巴结活检术在乳腺癌手术中的应用

目的探讨乳腺癌手术治疗中前哨淋巴结活检术的应用价值。方法选取2013年2月至2016年12月间海南省中医院收治的80例接受乳腺癌手术治疗的患者,采用随机数表法分为观察组(接受前哨淋巴结活检术)与对照组(未接受前哨淋巴结活检术),每组40例。比较两组患者治疗前后血清肿瘤标志物水平和不良反应情况。结果治疗后观察组患者血清肿瘤标志物癌脴抗原(CEA)、糖类抗原(CA153)和糖类抗原(CA125)分别为(2.36±0.56)ng/ml、(13.21±5.53)U/ml和(15.64±5.43)U/ml,对照组患者分别为(3.28±0.86)ng/ml、(14.86±4.53)U/ml和(16.98±6.69)U/ml,两组均较治疗前明显降低,且观察组患者较对照组降低更多,差异均有统计学意义(均P<0.05)。对照组患者皮下积液、上肢水肿和上肢活动受限等并发症发生率合计为40.0%,观察组患者为7.5%,两组比较,差异有统计学意义(P<0.05)。结论前哨淋巴结活检辅助乳腺癌手术能够避免不必要的淋巴结清扫,减少机体损伤,降低不良反应发生率,且不会对手术效果造成影响,可在临床中推广。     

Sentinel lymph node biopsy and axillary lymph node dissection

Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary status and obviating axillary dissection in patients with node-negative breast cancer. A combination of dye- and gamma probe-guided methods can identify SLN more accurately and easily than either of these techniques alone. On the other hand, SLN biopsy is highly accurate and sensitive in patients with small tumors, and no false-negative SLN biopsy has been reported for a breast cancer < 1.0-1.5 cm. Moreover, extensive intraoperative examination of SLNs using frozen sections can attain a sensitivity comparable to that obtained by histologic examination on the permanent sections. In practice, therefore, axillary dissection can be avoided in patients with small tumors in whom the SLNs are negative.     

Sentinel lymph node biopsy in melanoma

The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy for melanoma has emerged during the last 2 decades as a minimally invasive approach to evaluate regional lymph node basins in patients with intermediate- and high-risk primary cutaneous melanoma and has changed our approach to the clinically negative lymph node basin in melanoma during the same period. This review focuses on preoperative assessment and operative strategies, pathologic evaluation of the SLN, issues related to regional lymph node basin control, and current clinical practice guidelines. Predictors of SLN status, the prognostic significance of the SLN, and areas of controversy are also discussed.