Relationship between Full-Field Digital Mammographic Features and Clinicopathologic Characteristics in 176 Cases with Breast Cancer

OBJECTIVE Different mammographic features are probably predictive of different prognosis. However, ambiguity still exists in understanding the relationship between them. In resent years, digital mammography has been available for clinical use which has led to a revolution in the resolving of images and an increase in early-stage breast cancer detection. Based on the above knowledge, this study was performed to evaluate the relationship between full-field digital mammographic features and clinicopathologic characteristics in breast cancer. METHODS Digital mammograms of 176 patients with pathologically proven breast cancer were reviewed. Also, clinical and pathologic records （histological types and axillary lymph nodes status） were retrospectively examined. RESULTS Most of the patients with a solitary microcalcification were young women under the age of 50（84.4%）, but the majority of the patients with microcalcifications complicated by a mass were elderly women. Microcalcifications detected by mammography occurred frequently in ductal carcinoma in situ （28.1%） and in early invasive carcinoma （15.6%）. Breast cancers with expression of microcalcifications combined with a spiculate mass had a high metastatic rate of axillary lymph nodes （69.4%）. A high metastatic rate of axillary lymph nodes was also found in the patients with solitary worm-like microcalcifications （57.1%）, solitary spiculate mass （53.7%） and solitary non-worm-like microcalcifications （44.4%）. Simple worm-like microcalcifications accompanied with metastasis of 4 to 9 axillary lymph nodes occurred in 42.9% of the（6/14） cases. The patients with microcalcifications combined by a spiculate mass and with metastasis of 4 to 9 axillary lymph nodes accounted for 27.8% （10/36） of the cases, and those with metastases of 10 and over accounted for 16.7% （6/36）. CONCLUSION Solitary microcalcifications occur frequently in young women and are usually associated with early breast cancer. There is a close relationship between worm-like microcalcifications, a spiculate mass and positive metastases of axillary lymph nodes, which are an index of poor prognosis.     

Signif icance of Sentinel Lymph Node Biopsy and Immunohistochemistry in Diagnosis and Staging of Stage-cN0 Oral Squamous Cell Carcinoma

OBJECTIVE To assess the signifi cance of sentinel lymph node biopsy (SLNB), serial section and cytokeratin immunohistochemical staining in the diagnosis and staging of Stage-cN0 oral squamous cell carcinoma (OSCC). METHODS A blue stain, 99mTc-dextran SPECT lymphoscintigrapgy and intraoperative γ-ray probes were used to examine the sentinel nodes in 31 cases with Stage-cN0 oral cancer. The H&E staining and a cytokeratin AE1/ AE3 immunohistochemistry (IHC) assessment, with serial sections, were conducted to provide results obtained from a routine pathological examination of lymph nodes. The value of the routine pathological examination of the sentinel lymph node (SLN), serial sections and IHC determination for cervical lymph node metastasis of Stage-cN0 OSCC was appraised. RESULTS A total of 45, 55 and 51 SLNs were examined in 25 (80%), 31 (100%) and 30 (96.5%) of the cases, by using the blue stain, γ-ray probes, and SPECT lymphoscintigraphy, respectively. The average SLNs found in each case of the groups was 1.4 (1 to 3) and there were 1,302 non-NSLNs. Six positive SLN metastases were detected by routine pathological examination, among which 1 case was found to be an accompanied positive metas-tasis of non-SLN. One positive SLN metastasis was found after examination of serial sections plus routine H&E staining and 2 were detected using serial sections plus AE3 immunohistochemical staining methods. No positive NSLNs were found in the study. CONCLUSION In order to make more progress in accurate SLNB diagnosis, serial sections and IHC (AE1/AE3) methods can be used for examination of the micrometastases which are diffi cult to identify by routine pathological sections and H&E staining.     

Sentinel lymph node identification in endometrial cancer

OBJECTIVE To evaluate the feasibility of intra-operative detection of sentinel lymph nodes （SLN） in the patient with endometrial cancer （EC）.
METHODS Thirty-one patients with Stage Ⅰ and Ⅱ endometrial cancer, who underwent a hysterectomy and a lymphadenectomy, were enrolled in the study. At laparotomy, methylene blue dye tracer was injected into the subserosal myometrium of corpus uteri at multiple sites, and dye uptake into the lymphatic channels was observed. The blue nodes which were identified as SLNs were traced and excised. The other nodes were then removed. All of the excised nodes were submitted for pathological hematoxylin and eosin （H＆E） staining examination.
RESULTS Failure of dye uptake occurred in 4 of the 31 cases （12.9%） because of spillage, and no lymphatic coloration was observed there. Lymphatic staining was clearly observable as blue dye diffused to the lymphatic channels of the uterine surface and the infundibulopelvic ligaments in 27 （87.1%） cases. Concurrent coloration in the pelvic lymphatic vessels was also observed in 22 of the 27 patients. The SLNs were identified in 23 of the 27 （85.2%） cases with a lymphatic staining, with a total number of 90 SLNs, and a mean of 3.9 in each case （range, 1-10）. Besides one SLN （1.1%） in the para-aortic area, the other 89 （98.9%） were in the nodes of the pelvis. The most dense locations of SLNs included obturator in 38 （42.2%） and interiliac in 19 （21.1%） cases. In our group, pelvic lymphadenectomy was conducted in 27 （87.1%） patients and pelvic nodal sampling in 4 （12.9%）. Of the 31 cases, a concurrent abdominal para-aortic lymph node sampling was conducted in 7. A total of 926 nodes were harvested, with an average of 39.8 in each case （range, 14-55）. Nodal metastases occurred in 3 patients （9.7%）, 2 of them with SLN involvement and the other without SLN involvement. Adverse reactions or injury related to the study was not found.
CONCLUSION Application of methylene blue dye is feasible in an intra-operative SLN identification of endometrial cancer. The technology is convenient, safe, and worth further investigation.     

STAT1 and Survivin Expression in Full Lymph Node Examined Gastric Cancer by Using Tissue Microarray Technique

Objective： To characterize the relationship between STAT1 and Survivin expression, and the relationship between them and lymph node metastasis, depth of invasion and prognosis in full lymph node examined gastric cancer patients of China. Methods： Specimens of curative dissection between 1988 and 2003 were collected from the affiliated hospital of Jianghan University. All 140 patients had complete examination data. All lymph nodes were found by clearing fat method. The interrupted serial 4 μm sections, routine hematoxylin and eosin staining and immunohistochemical methods were used to detect the lymph node metastases. Gastric cancer tissue microarray was formed and the expression of survivin and STAT1 in gastric cancer was detected by immunohistochemical method. All data were processed using Spearman rank correlation analysis, Kaplan-Meyer Log-rank method and Cox multivariate analysis （SPSS 12.0 software）. Results： Among 140 gastric cancer tissue microarrays constructed, 110 could be used （utilization rate was 78.6%）. 7079 lymph nodes were found in 110 cases （64.4/case）. Metastases were found in 89 cases and 1679 lymph nodes. Positive expression rate of survivin and STAT1 was 52.7% （58/110） and 40% （44/110） respectively. There was a significant negative correlation between STAT1 expression and survivin expression （r=-0.19, P=0.04）. STAT1 expression had a negative correlation with depth of invasion （r=0.21, P=0.04）. Survivin expression had a negative correlation with UICC N stage （r=-0.24, P=0.01） and histological classification （r=-0.21, P=0.03） by Spearman rank correlation analysis. But survivin and STAT1 expression was not related with prognosis. A significant correlation between lymph node metastasis and prognosis was demonstrated by Cox multivariate analysis （X^2=4.85, P=0.028）. Conclusion： STAT1 has a negative correlation with survivin expression in gastric cancer. Both of them have no correlation with prognosis in gastric cancer. STAT1 expression can be a molecular marker to predict advanced gastric cancer and survivin a molecular marker of lymph node metastasis in gastric cancer. UICC N stage is the most important prognostic factor in gastric caner in China.     

Significance of Sentinel Lymph Node Biopsy and Immunohistochemistry in Diagnosis and Staging of Stage-cNO Oral Squamous Cell Carcinoma

OBJECTIVE To assess the significance of sentinel lymph node biopsy （SLNB）, serial section and cytokeratin immunohistochemical staining in the diagnosis and staging of Stage-cNO oral squamous cell carcinoma （OSCC）, METHODS A blue stain, 99mTc-dextran SPECT lymphoscintigrapgy and intraoperative y-ray probes were used to examine the sentinel nodes in 31 cases with Stage-oNO oral cancer, The H＆E staining and a cytokeratin AE1/ AE3 immunohistochemistry （IHC） assessment, with serial sections, were conducted to provide results obtained from a routine pathological examination of lymph nodes, The value of the routine pathological examination of the sentinel lymph node （SLN）, serial sections and IHC determination for cervical lymph node metastasis of Stage-cN0 OSCC was appraised, RESULTS A total of 45, 55 and 51 SLNs were examined in 25 （80%）, 31 （100%） and 30 （96,5%） of the cases, by using the blue stain, y-ray probes, and SPECT lymphoscintigraphy, respectively, The average SLNs found in each case of the groups was 1,4 （1 to 3） and there were 1,302 non-NSLNs, Six positive SLN metastases were detected by routine pathological examination, among which 1 case was found to be an accompanied positive metastasis of non-SLN, One positive SLN metastasis was found after examination of serial sections plus routine H＆E staining and 2 were detected using serial sections plus AE3 immunohistochemical staining methods, No positive NSLNs were found in the study, CONCLUSION In order to make more progress in accurate SLNB diagnosis, serial sections and IHC （AE1/AE3） methods can be used for examination of the micrometastases which are difficult to identify by routine pathological sections and H＆E staining.     

IMMUNOCHEMICAL IDENTIFICATION AND LOCALIZATION OF CYTOCHROME P-450HSjISOZYME, AN ENZYME RELATED TO NITROSAMINE METABOLISM, IN HUMAN GASTRIC MUCOSA AND GASTRIC CARCINOMA

Monoclonal antibody (MAb) to rat liver cyto-chrome P-450j isozyme, an activating enzyme specific to nitrosamine metabolism, was used coupled with immunoblotting, densitometer scanning of SDS-PAGE gels and immunohistochemical technique. The trace P-450HSj isozyme (Mr. 51.5 Kd) was found in human gastric mucosa. It was similar to P-450j in molecular weight, catalytic and immunochemical properties. The concentrations of P-450HSj in mucosa of lesser curvature were higher than those in greater curvature. This might be one of the important reasons that lesser curvature is the commonest area for gastric carcinoma. But there was possibly less P-450HSj in gastric mucosa with cancer. Im-munohistochemically, P-450HSj was discovered in the cytoplasm of some glandular epithelial cells, especially in the glands with hyperplastic and intestinal metaplastic changes adjacent to carcinoma. It was also found in some normal glands and in tumor cells of high-differentiated adenocarcinoma, but not in those of low-differentia     

SOME PROBLEMS IN THE SURGICAL TREATMENT OF GASTRIC CANCER

Radical resections were performed in 177 cases of gastric cancer ( early cancer 31 cases and advanced cancer 146 cases). R1 operation was performed in 10 cases and R2 or R3 was in 167. All patients were followed up to the end of the study with the 5-year survival rate of 57. 6%. In the patients with normal serosa, cancer was often located in the mucosa. In such situation, R1 or R1 operation was advisiable. In the patients of reactive serosal types, the extent of operation should not be reduced. The serosa were often penetrated by cancer cells in diffusely infiltrated cancer, with a poor prognosis. If measures were not taken to destroy free cancer cells, the 5-year survival rate was very low inspite of radical operations. The number of lymph nodes metastasis was closely related to the biological behavior of primary cancer. Prognosis was good after R2 or R3 operation when the cancer was still within the gastric wall, Borrmann type 1,2,3 massive or nest growth patterns, and the number of lymph node metas     

DIAGNOSTIC FACTOR OF N STAGING IN RECTAL CARCINOMA： A COMPUTERED TOMOGRAPHY STUDY CORELATED WITH PATHOLOGICAL FINDING

Objective： To investigate the characteristic findings in CT images associated with N-staging of rectal carcinoma. Methods： Fifty nine patients underwent radical resection for rectal carcinoma after preoperative CT examinations, pN0, pN1, and pN2 were classified based on the pathological examination of excised specimens according to the AJCC N-staging criterion. Images were reviewed by two radiologists using CT cine blindly, reaching a consensus on size, number and distribution of lymph nodes, serosa behavior and circumferential infiltration of rectal carcinoma. The relationship between lymph node metastases and CT findings was analyzed statistically with SAS using k-w test and x^2 test. Results： Lymph nodes were depicted in all node-positive cases. The mean diameters of the largest nodes displayed in the groups of pN0, pN1, pN2 were 3.84 mm, 5.60 mm and 6.79 mm respectively; the diameters showed a statistically significant increase with N-stage developing （H=23.842, P〈0.01）. The mean numbers of lymph nodes in the groups of pN0, pN1 and pN2 were 3.0, 4.5 and 9.0 respectively, which also showed an increasing trend and significant differences from each other （H=21.834, P〈0.01）. The summation diameters of all depicted nodes also showed a significant difference in the NO, N1 and N2 groups （H=32.037, P〈0.001）. Positive nodes were seen in 25% （3/12） of cases with perirectaUy displayed nodes, in 58.6%（17/29） of cases with lymph nodes distributed both perirectally and along the superior rectal artery, and in 72.7%（8/11） of cases with nodes detected along iliac vessels combined with either one of the previous two distributions patterns. The distribution patterns of lymph nodes were significantly different in NO, N1 and N2 groups （x^2=19.517, P〈0.05）. The disorder of serosa behavior and circumferential infiltration of rectal carcinoma were more likely to occur in node positive group than negative group with statistical significance （x^2=8.979, P〈0.01, x^2=5.107, P〈0.05）. Conclusion： Comprehensively considering the size, number, distribution of depicted lymph node, as well as serosa disorder and circumferential infiltration of rectal carcinoma would be helpful for improving the N-staging of CT in patients with rectal carcinoma preoperatively.     

清扫淋巴结数和N1淋巴结阳性数与Ⅱ期非小细胞肺癌预后的关系

Objective The aim of this study was to evaluate if factors associated with dissected lymph nodes affect the outcome of completely resected stage II (T1-2N1) non-small cell lung cancer (NSCLC). Methods Clinical data of 121 patients with complete resection of stage II NSCLC in Sun Yat-sen University Cancer center from January 1998 to December 2004 were reviewed retrospectively and the effect of factors of dissected lymph nodes on overall survival (OS) and disease-free survival ( DFS) of NSCLC was analyzed.Results The univariate analysis demonstrated that the total number of removed lymph nodes, the number of involved N1 lymph nodes, the ratio of involved N1 lymph nodes and the total number of removed N2 lymph nodes were significant prognostic factors for OS. In the multivariate analysis, the total number of removed lymph nodes and the number of involved N1 lymph nodes were independent prognostic factors for OS. In both of univariate and multivariate analyses, tumor size, the total number of removed lymph nodes and the number of involved N1 lymph nodes were independent prognostic factors for DFS.Conclusion For patients with completely resectable stage II NSCLC, 10 or more lymph nodes should be removed at the surgical resection. Total number of removed lymph nodes ≥ 10 is a favorable prognostic factor and involved N1 ≥ 3 is an adverse one.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胃癌孤立淋巴结转移的影像研究

[目的]评价CT在胃癌孤立淋巴结转移中的诊断作用。[方法]回顾性分析胃癌孤立淋巴结转移患者75例临床资料。[结果]75例患者中,68例淋巴结转移位于胃周（N1）。另有7例患者淋巴结跳跃转移至N2～N3站,CT对孤立淋巴结转移胃癌患者T分期、N分期及M分期的准确率分别为73-3％、78．7％和90％。[结论]并非每个前哨淋巴结都位于胃周原发病灶附近。CT在孤立淋巴结转移胃癌患者TNM分期上的准确性较高。     

前哨淋巴结活检在胃癌根治术中的应用

目的：探讨前哨淋巴结活检（SLNB）在胃癌根治术中临床应用的可行性及其价值。方法：应用美蓝对55例胃癌患者行SLN定位活检,分体内、体外组,采用HE染色病理检查法、CK20免疫组化染色检测SLN中转移癌。结果：共检出淋巴结560枚,其中SLN 262枚,检出率85.7%。免疫组化学法检测SLN癌转移的敏感性明显高于HE染色,而假阴性明显低于后者（P〈0.05）。结论：胃癌根治术中行前哨淋巴结活检技术,具有切实的可行性,能够预测区域淋巴结的转移状况;通过IHC法检查有助于明确胃癌的病理分期,有利于判断预后和个体化治疗方案的制定。     

早期宫颈癌盆腔淋巴结转移的分布

目的 探讨早期宫颈癌患者盆腔淋巴结转移的规律,提出宫颈癌盆腔淋巴结三级分站的可行性.方法 选取196例行广泛子宫切除和盆腔淋巴清扫术的Ⅰa2～Ⅱa期宫颈癌患者为研究对象,术前在宫颈肿瘤周围黏膜下3、6、9、12点处分别注射99mTc-硫胶体0.5ml,术后将清扫的盆腔淋巴结用闾讲庖墙刑逋馓讲?确定放射活性计数比同侧淋巴结升高5倍者为前哨淋巴结,将切除的盆腔淋巴结连续切片行HE染色进行病理检测.结果 共检出41例患者的83枚转移盆腔淋巴结,其中宫旁和闭孔淋巴结转移65枚,髂内外淋巴结转移17枚,髂总淋巴结转移1枚.22例宫旁淋巴结转移患者中,同时伴有髂内淋巴结转移者3例,髂外淋巴结转移者5例,髂内和髂外淋巴结均转移者1例.19例闭孔淋巴结转移患者中,同时伴有髂内淋巴结转移者3例,髂外淋巴结转移者4例.x2检验显示,宫旁和(或)闭孔淋巴结转移与盆腔其他区域淋巴结的转移呈正相关.共检出转移前哨淋巴结81枚,其中宫旁和闭孔前哨淋巴结转移64枚,髂内外前哨淋巴结转移17枚.宫旁和(或)闭孔淋巴结转移组与非转移组比较,患者的1和3年生存率差异无统计学意义,但非转移组患者的5年生存率(93.2%)明显高于转移组(65.1%).结论 宫颈癌患者的盆腔淋巴结转移分为三站是可行的,第1站为宫旁和闭孔区域淋巴结,第2站为髂内和髂外淋巴结,第3站为髂总和腹股沟深淋巴结,可根据转移情况合理地制定患者的治疗方案.     

胸段食管癌孤立性淋巴结转移规律及其临床价值

探讨胸段食管癌孤立性淋巴结转移的规律及其临床价值,为指导食管癌淋巴结清扫范围提供理论依据。方法:回顾性分析66例发生孤立性淋巴结转移胸段食管癌病例的临床病理资料,探明孤立性淋巴结转移的常见部位,分析其与肿瘤所在部位、浸润深度的关系,并对本组患者预后进行单因素分析。结果:本组食管癌孤立性淋巴结中喉返神经旁、食管旁和胃周为淋巴结转移高发组,跳跃性淋巴结转移20例（30.3%）。浅表型食管癌孤立性淋巴结常集中分布于2～3个区域,而进展型广泛分布于颈、胸、腹各组淋巴结。孤立性淋巴结转移组与无转移组术后5年生存率分别为36.4%和42.8%,差异有统计学意义。跳跃性与非跳跃性淋巴结转移组术后5年生存率分别为35.0%和36.9%,差异无统计学意义。单因素分析发现,浸润深度是影响本组患者预后的独立因素。结论:胸段食管癌孤立性淋巴结分布与肿瘤部位、浸润深度密切相关,双侧喉返神经旁、食管旁及胃周淋巴结是其高发部位。      

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。     

乳腺癌前哨淋巴结临床病理的研究

目的：探讨乳腺癌前哨淋巴结能否准确反映腋窝淋巴结转移情况,方法对36例例早期乳腺癌,常规HE染色检测腋窝淋巴结,对HE染色阴性的前哨淋巴结及所属非前啉巴结,连续切片、免疫组化染色,检测其肿瘤的转移情况,结果常规病理检测36例中,10例腋窝有转移,其中2例仅哨淋巴结有肿瘤转移,连续切片,组化检测26例阴性的前哨淋巴结共61例,非前哨淋巴结406枚,2例（2枚）仅前哨淋巴结发现有肿瘤转移,余245例前哨淋巴结及非前哨淋巴结无肿瘤转移,HE染色的检测阴性的前哨淋巴结患者假阴性率为7．7％（2／26）。结论早期腺癌前哨淋巴结可以准确反映腋窝巴结转移情况。     

前哨淋巴结识别技术在子宫内膜癌的研究

目的 :探讨在子宫内膜癌淋巴结切除术中进行前哨淋巴结(SLN)识别的可行性。 方法 :选择接受手术治疗的临床Ⅰ、Ⅱ期子宫内膜癌患者31例。术中将示踪剂亚甲蓝分多点注射于子宫浆膜下,进而追踪识别蓝染的淋巴结为SLN。切取SLN后再行其它淋巴结切除,SLN与其它淋巴结分送常规病理检查。 结果 :31例中4例(12.9%)在注射亚甲蓝过程中发生泄漏,无淋巴管着色。其余27例(87.1%)均有子宫浆膜面及双侧骨盆漏斗韧带内的淋巴管着色,其中22例盆腔内淋巴管同时着色。27例淋巴管着色的病例中23例(85.2%)识别出SLN,共计90枚,平均每例3.9枚(1～10枚)。除1枚(1.1%)SLN位于腹主动脉旁区域外,其余89枚(98.9%)分布于盆腔的各组淋巴结中,主要为闭孔38枚(42.2%)、髂内19枚(21.1%)。本组中27例(87.1%)患者接受了盆腔淋巴结清扫术,4例(12.9%)行盆腔淋巴结取样术。31例中7例(22.6%)同期行腹主动脉旁淋巴结取样术。手术共切除淋巴结926枚,平均每例29.8枚(14～55枚)。3例(9.7%)患者发生淋巴结转移,其中2例SLN转移,另1例转移患者无SLN检出。未发现与本研究相关的损伤及不良反应。 结论 :应用亚甲蓝在子宫内膜癌术中进行SLN识别具有可行性,此技术简便、安全,值得进一步探讨。     

Sentinel lymph node biopsy in gastric cancer: Possible applications and limits

Aims

To explore the feasibility and accuracy of sentinel lymph node (SLN) biopsy in gastric cancer.

Patients and Methods

Twenty-nine patients with clinical T1 and T2 N0 M0 gastric cancer less than 5 cm in diameter underwent SLN biopsy with the intraoperative Patent blue method. The procedure continued with radical gastrectomy and D2 lymphadenectomy. We investigated all technical aspects of the blue dye technique and determined the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the SLN technique.

Results

SLNs were detected in 28 of 29 patients; the total number of excised SLNs was 45, with a median of two (range 1-3). Seventeen patients had metastatic SLN, with 21 lymph nodes retrieved. Twenty-two patients had SLNs located at the first level. Four patients had SLNs at the second level, one at the first and second levels, and one at the first and third levels. Five patients had false negative SLNs. The ability of SLN biopsy to predict the status of the other lymph nodes was summarised by an accuracy of 75%, a sensitivity of 75%, a specificity of 75%, a positive predictive value of 88%, and a negative predictive value of 55%.

Conclusions

Our study demonstrates that pick-up SLN biopsy in gastric cancer is technically feasible but has very low sensitivity. Regarding the utility of SLN navigation when attempting to detect the nodal basin, the high rate of false negative SLNs and lymph node level jumping warrant further studies with a large accrual before the method can be introduced into daily practice.     

Lymph node dissection around the splenic artery and hilum in advanced middle third gastric carcinoma

Aim

To evaluate the clinicopathological factors influencing lymph node metastasis around the splenic artery and hilum and the effect of spleen-preserved lymphadenectomy in advanced middle third gastric carcinoma.

Methods

We retrospectively studied 131 patients with advanced middle third gastric carcinoma who had received D2 lymphadenectomy and lymph node dissection around the splenic artery and hilum, from 2000 to 2004. Of these patients, 62 simultaneously underwent splenectomy and 69 underwent spleen-preserved lymphadenectomy.

Results

The incidences of Nos. 10 and 11 lymph node metastases were 21% and 15%, respectively, in advanced middle third gastric carcinoma. A tumor size larger than 5 cm, metastases of Nos. 1 and 7–9 lymph node were independent risk factors for metastasis of No. 10 and/or No. 11 lymph node. The spleen-preserved group had a slightly better survival rate and a relatively lower rate of postoperative complications than the splenectomy group. No. 10 and/or No. 11 lymph node metastasis was an independent prognostic factor, while splenectomy was not.

Conclusions

It is necessary to remove the lymph nodes around the splenic artery and hilum to achieve radical resection in advanced middle third gastric carcinoma patients with risk factors. Our results demonstrate that spleen-preserved lymphadenectomy is a good option for those patients.     

小细胞肺癌胸内淋巴结转移规律对确定放疗范围的意义

目的 通过分析小细胞肺癌(small cell lung cancer,SCLC)胸内淋巴结转移方式和规律,探讨SCLC放疗靶区的合理范围.方法 对本院150例接受根治性切除及系统性淋巴结清扫的局限期SCLC患者的胸内淋巴结进行分组及病理检查,分析胸内各组淋巴结的转移方式和规律.结果 150例SCLC患者共清扫胸内631个组的2372个淋巴结,经病理证实188个组(29.8％)的413个淋巴结(17.4％)存在转移,88例(58.7％)患者存在胸内淋巴结转移.胸内淋巴结转移率较高的是11、10、7、5、4组,中央型、T分期晚的患者更易发生淋巴结转移(x2 =15.32、39.72,P=0.000、0.000).右肺上叶和中下叶肺癌淋巴结高危转移区域分别为4、7、10组和4、7、10、11组,左肺上叶和下叶肺癌淋巴结高危转移区域分别为4、5、6、10组和4、7、9、10、11组.纵隔淋巴结转移72例,其中无肺门淋巴结转移的跳跃性转移29例(肺上叶癌主要向上纵隔淋巴结,肺中下叶癌可向上、下纵隔淋巴结).结论 SCLC胸内淋巴结遵循由肺内经肺门向纵隔依次转移的规律,但存在部分跳跃性转移;对不同肺叶肺癌对应的高危淋巴结转移区域给予预防照射有可能提高SCLC的放疗增益比.