Sentinel node detection in N0 cancer of the pharynx and larynx

Neck lymph node status is the most important factor for prognosis in head and neck squamous cell carcinoma. Sentinel node detection reliably predicts the lymph node status in melanoma and breast cancer patients. This study evaluates the predictive value of sentinel node detection in 50 patients suffering from pharyngeal and laryngeal carcinomas with a N0 neck as assessed by ultrasound imaging. Following 99m-Technetium nanocolloid injection in the perimeter of the tumour intraoperative sentinel node detection was performed during lymph node dissection. Postoperatively the histological results of the sentinel nodes were compared with the excised neck dissection specimen. Identification of sentinel nodes was successful in all 50 patients with a sensitivity of 89%. In eight cases the sentinel node showed nodal disease (pN1). In 41 patients the sentinel node was tumour negative reflecting the correct neck lymph node status (pN0). We observed one false-negative result. In this case the sentinel node was free of tumour, whereas a neighbouring lymph node contained a lymph node metastasis (pN1). Although we have shown, that skipping of nodal basins can occur, this technique still reliably identifies the sentinel nodes of patients with squamous cell carcinoma of the pharynx and larynx. Future studies must show, if sentinel node detection is suitable to limit the extent of lymph node dissection in clinically N0 necks of patients suffering from pharyngeal and laryngeal squamous cell carcinoma.     

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.     

Podoplanin expression correlates with sentinel lymph node metastasis in early squamous cell carcinomas of the oral cavity and oropharynx

In patients with early head and neck squamous cell carcinoma (HNSCC), occult lymph node metastasis is difficult to predict by clinical or pathological parameters. However, such parameters are necessary to select patients either for elective neck dissection or the sentinel lymph node (SLN) procedure. The membrane glycoprotein podoplanin is normally expressed in lymphatic endothelial cells. Recently, expression of podoplanin by cancer cells was demonstrated to promote tumor cell motility and tumor lymphangiogenesis in vitro. The value of cancer cell-expressed podoplanin was to be determined as a predictive marker for SLN metastasis in early HNSCC of the oral cavity and oropharynx. One hundred twenty patients with HNSCC of the oral cavity and oropharynx undergoing a SLN biopsy were enrolled in this prospective clinical trial of SLN biopsy. Cancer cell-expressed podoplanin was determined by immunohistochemistry using tissue microarrays. Podoplanin expression was quantified by the intensity reactivity score and categorized into expression and nonexpression. SLN examination revealed occult metastasis in 45 patients (37.5%). Twenty-nine of 120 (24.2%) primary HNSCC showed podoplanin expression. Podoplanin expression correlated significantly with SLN metastasis (p = 0.029) and remained a significant predictor for lymph node status even after controlling for tumor stage (p = 0.028). As a predictive marker for SLN metastasis, however, podoplanin expression reached a sensitivity of a mere 36% and a specificity of 83%. Podoplanin expression is associated with metastasis to lymph nodes in vivo. Podoplanin immunohistochemistry in early HNSCC of the oral cavity and oropharynx may help to select patients for the SLN procedure and to identify patients with increased risk for presence of occult lymph node metastasis in the neck.     

前哨淋巴结检测13例头颈鳞癌应用分析

[目的]评价头颈鳞癌中前哨淋巴结（SLN）的意义。[方法]回顾性分析2001～2002年收治的13例头颈鳞癌患者（10例cN0,3例cN1）接受前哨淋巴结检测的临床资料。[结果]10例cN0头颈鳞癌患者全部探测出SLN,3例cN1患者中2例淋巴结阳性。全部患者随访26～68个月,1例死于第二原发癌肺癌,2例死于局部复发。[结论]头颈鳞癌颈部cNn的前哨淋巴结检测对发现隐性转移灶是可行的。     

Lymphatic mapping and sentinel lymph node biopsy in squamous cell carcinoma of the lower lip.

AIMS: The risk of metastases to the submandibular and submental lymph nodes in squamous cell carcinoma (SCC) of the lower lip is closely related to the primary tumour size and the differentiation of the tumour. In order to determine the feasibility of the technique and the possible metastatic lymph nodes in SCC of the lower lip, intraoperative lymphatic mapping and sentinel lymph node biopsy was performed in patients with tumour size greater than 2 cm (T2) and clinically non-palpable regional lymph nodes (N0). METHODS: Intraoperative lymphatic mapping with patent blue dye was performed in 20 patients with SCC of the lower lip. The stained lymph node (sentinel) was identified in each patient and sent for frozen section analysis in order to verify tumour metastasis. All patients had undergone bilateral suprahyoid neck dissection at the same stage. RESULTS: Three of the patients were female and 17 were male. The median age was 66. Sentinel lymph nodes were identified in 18 of the patients (90%). Intraoperative or post-operative histopathologic examination of the sentinel lymph node showed tumour metastasis in three of the patients (16.6%). The histopathologic examination of the remaining 15 patients whose sentinel lymph nodes were free of metastasis, showed no metastasis in the non-sentinel lymph nodes. In two of the three patients with metastatic sentinel lymph nodes, non-sentinel lymph nodes were free of metastases. There were no false negative results and no local or systemic complications of the technique were seen among the patients. CONCLUSIONS: Intraoperative lymphatic mapping and sentinel lymph node biopsy is feasible in patients with SCC of the lower lip who have large tumour size and non-palpable regional lymph nodes. The technique may help to avoid neck dissection when the patient has negative sentinel lymph node and when positive provides useful information for more effective radical treatment.     

A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography

OBJECTIVES: Pre-operative staging of the clinically N(0) neck in patients with oral squamous cell carcinoma is hindered by the relatively high false negative/positive rates of conventional imaging techniques. The aim of this study is to evaluate the utility of (18)F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET) and sentinel lymph node (SLN) imaging and biopsy to determine the true disease status of the loco-regional lymphatics. METHODS: Nineteen patients with biopsy proven disease without palpable or radiological evidence of neck metastases underwent pre-operative (18)F-FDG PET and SLN imaging. All patients underwent whole-body FDG PET and a single view of the head and neck. SLN technique was performed using four peri-tumoural injections of (99m)Tc labeled albumin colloid each of 10 MBq. Dynamic and static imaging followed in the antero-posterior and lateral projections. At operation 1 ml of 2.5% Patent Blue Dye and a hand held gamma probe (Neoprobe 1500) were used in combination to identify and remove the SLN. Surgery then continued along conventional lines including a neck dissection. Histology of the resultant specimen was correlated with that of the SLN and pre-operative imaging. RESULTS: In all patients SLN harvesting was feasible. In 15/19 patients the SLN(s) and the residual neck dissection were -ve for tumour. In 3/19 patients the SLN(s) were +ve for tumour as were other neck nodes. In 1/19 patients the SLN was -ve but another single tumour +ve node was identified in the neck. This patient occurred early in our series with a SLN close to the primary tumour. (18)F-FDG PET failed to identify nodal disease in all four patients with histologically proven lymph node metastases. The size of these nodes ranged from 12 mm x 10 mm x 3 mm to 25 mm x 15 mm x 10 mm. CONCLUSION: SLN imaging and biopsy with probe and Patent Blue Dye guided harvest is feasible in patients with oral squamous cell carcinoma and can predict cervical nodal status. (18)F-FDG PET may be less useful.     

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。     

舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响

背景与目的:舌鳞癌隐匿性颈淋巴结转移有一定的规律性,且影响预后。本研究的目的是分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响,为选择性肩胛舌骨肌上颈清扫提供临床依据。方法:收集1990～1996年间在我院住院行手术治疗的164例舌鳞癌患者的资料,分析舌鳞癌隐匿性颈淋巴结转移的特点及其对患者预后的影响。结果:164例舌鳞癌隐匿性颈淋巴结转移率为25.71%,最常见的转移部位是同侧的Ⅱ区,其次分别为同侧的Ⅰ和Ⅲ区,82.98%隐匿性转移的颈淋巴结位于以上3个区域,大多数隐匿性转移的颈淋巴结在首次手术治疗后2年内(33/36)被发现。经统计学分析,显性颈淋巴结转移和隐匿性颈淋巴结转移与无转移组之间患者的预后有显著性差异(log-rank,P<0.01),而显性转移组与隐匿性转移组患者的预后之间无显著性差异(log-rank,P>0.05)。结论:同侧的Ⅰ～Ⅲ区是舌鳞癌隐匿性颈淋巴结转移的常见区域,对较易发生隐匿性颈淋巴结转移的cN0舌鳞癌患者可行选择性肩胛舌骨肌上颈清扫术。隐匿性颈淋巴结转移影响cN0舌鳞癌患者的预后。     

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.     

Le ganglion sentinelle dans les carcinomes épidermoïdes de la tête et du cou

Node involvement is a major prognostic factor in head and neck cancers. Among N0 staged patients, because 15 to 30% have occult node metastasis, systematic radical modified neck dissection is frequently performed, although it is subsequently demonstrated to have been unnecessary in two thirds of the cases. With respect to minimal invasive surgery, an understanding of the head and neck lymphatic anatomy and experience of sentinel node biopsy in cutaneous melanoma and breast cancer endorse such an approach, particularly for T1–T2 N0 head and neck squamous cell carcinoma of the oral cavity and oropharynx. Progress in histological diagnosis is expected by way of targeted cervical lymphatic molecular analysis.     

舌体鳞癌前哨淋巴结的放射性胶体定位

背景与目的:目前缺乏一种特异性的诊断手段能在术前准确地评价临床颈淋巴结阴性(clinically negetive neck,cN0)舌癌患者的颈部隐匿性转移状况,所以其颈部的手术处理还存在争议.而前哨淋巴结(sentinel lymph node,SLN)活检的应用可能为cN0舌癌患者颈部个体化治疗提供依据.本研究旨在探讨cN0舌体鳞癌前哨淋巴结放射性胶体定位的可行性,以及前哨淋巴结检测的临床价值.方法:选择21例cNO患者,其中初诊者20例,原发灶有手术史者1例.手术当天于舌肿瘤周围多点注射99mTc-SC,尽量包绕肿瘤,全部患者术前及术中用γ探测仪探测SLN,其中5例患者结合使用术前核素扫描示踪SLN,全部患者行肩胛舌骨肌上颈清扫,以颈清扫标本的常规病理结果为金标准,评价放射性胶体定位SLN的准确率.对常规病理检查阴性的SLN进一步行免疫组化检查.结果:21例患者定位到SLN(共41枚),SLN检出率为100%(21/21),其中20例患者SLN的病理检查结果与颈清扫的病理检查结果相符合,准确率95%(20/21).1例患者SLN病理阴性,而颈清扫标本出现阳性淋巴结,为假阴性.多层切片加免疫组化微转移检出率为7.3%(3/41).结论:舌癌SLN放射性胶体定位是可行的,SLN活检能较好地预测颈部淋巴结转移状况,但其临床应用价值还需进一步研究.     

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。     

Predictors of non-sentinel lymph node metastasis in breast cancer patients

In many patients, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients would not be expected to benefit from completion axillary lymph node dissection (CALND). This study evaluated the factors that may determine the likelihood of additional positive nodes in the axilla in the presence of sentinel node metastasis. A total of 618 breast cancer patients underwent SLN biopsy based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 99mTc-nanocolloid and Patent Blue V injected peritumourally. This was followed by standard axillary node clearance at the same operation. Of the 201 patients with a positive SLN, 105 (52%) patients had no further positive nodes in the axilla, 96 (48%) patients had additional metastasis in non-sentinel lymph nodes (NSLN) upon CALND. In patients with a positive SLN, increasing tumour size and tumour grade significantly increased the frequency of additional positive nodes on univariate analysis. The number of SLNs removed and the number of negative SLNs were significant negative predictors. Increasing tumour burden in the sentinel nodes (determined by the number of positive SLNs) was significantly associated with increasing likelihood of positive NSLNs. Multivariate analysis revealed that the rest of the axilla is more likely to be positive if there are more positive than negative SLNs removed and more likely to be negative otherwise. A group of cases from one centre (Cardiff) were subjected to further detailed analysis. Tumour burden in the positive SLN was assessed by measuring the size of metastasis, percentage replacement of the SLN by tumour and by documenting extracapsular extension (ECE) around the SLN. Of the 64 patients with a positive SLN, 34 (53%) patients had no further positive nodes in the axilla, 30 patients (47%) had additional metastasis in NSLNs upon CALND. Increasing tumour burden in the SLN was associated with additional positive nodes in the axilla. Multivariate analysis revealed that size of the SLN metastasis is the most important predictor of involvement of only the SLN. Overall, in patients with a positive SLN, the difference in the number of positive and negative SLNs removed and size of the metastasis in the SLN, all predicted the frequency of additional positive nodes.     

口腔鳞癌颈淋巴结转移的临床病理学特点及其对预后的影响

背景与目的口腔癌淋巴结转移率在50%～59%之间,对其处理好坏关系到患者的预后。本研究拟探讨影响口腔鳞癌颈淋巴结转移的临床病理因素及其对预后的影响。方法对191例口腔鳞癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究,并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域、转移颈淋巴结最低受累区域等淋巴结病理学因素对预后生存的影响进行Cox回归分析。结果口腔鳞癌患者5年生存率为48.7%。χ2分析显示,仅肿瘤浸润深度与发生颈淋巴结转移有关。Cox回归分析表明,临床N分期、颈淋巴结转移状态、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域因素影响患者预后,特别是临床N分期、转移颈淋巴结最低受累区域因素与口腔鳞癌患者预后明显相关。结论口腔鳞癌颈淋巴结转移是影响患者预后的重要因素,了解其颈淋巴结转移的规律,并对影响预后的淋巴结因素采取相应治疗措施,对提高口腔鳞癌治疗效果具有重要意义。     

The prognostic significance of lymph node micrometastasis in patients with esophageal carcinoma

BACKGROUND: Lymph node metastasis is a well known feature of poor prognosis in patients with esophageal adenocarcinoma and squamous cell carcinoma. However, a significant proportion of apparently lymph node negative patients die early of metastatic disease. The aim of this study was to determine the prevalence and prognostic significance of occult lymph node metastasis in patients with esophageal adenocarcinoma and squamous cell carcinoma. METHODS: Lymph node sections from esophagectomy specimens of 78 patients with lymph node negative esophageal carcinoma (49 patients with adenocarcinoma and 29 with squamous cell carcinoma) were cut serially, it toto, and immunostained with the cytokeratin antibody AE1/AE3 and evaluated for occult lymph node metastasis. The results were correlated with the clinical and pathologic features and with patient survival. RESULTS: Fifteen of 49 patients (31%) with adenocarcinoma and 5 of 29 patients (17%) with squamous cell carcinoma had occult lymph node metastasis detected by cytokeratin staining. In the adenocarcinoma patients, the presence of occult lymph node metastasis showed a significant correlation with increasing depth of invasion, but was not associated significantly with any other clinical or pathologic feature. In the squamous cell carcinoma patients, the presence of occult lymph node metastasis did not correlate significantly with any clinical or pathologic parameter, except that patients with occult lymph node metastasis were more likely to have received preoperative chemotherapy or radiation therapy. Occult lymph node metastasis did not correlate with poorer survival rates in patients with either adenocarcinoma (Cox proportional hazards ratio: 1.42; P - 0.46) or squamous cell carcinoma (Cox proportional hazards ratio: 0.86; P = 0.90). CONCLUSIONS: Occult lymph node metastasis is not an independent poor prognostic feature in esophageal adenocarcinoma or squamous cell carcinoma. Therefore, the authors do not recommend extensive lymph node sectioning with keratin immunostaining for prognostication of patients with these malignancies.     

Intradermal radioisotope injection optimises sentinel lymph node identification in breast cancer

AIM: Currently there is no consensus on the optimal technique for sentinel lymph node (SLN) identification in patients with breast cancer. The aim was to compare the efficacy of intraparenchymal and intradermal isotope injection in sentinel lymph node mapping for breast cancer. METHODS: One hundred and twenty-five patients with histologically confirmed invasive breast cancer underwent SLN mapping using radioisotope and isosulphan blue dye followed by a back-up axillary dissection. The first 80 patients had intraparenchymal (IP) injection of radioisotope given in four portions around the tumor. The remaining 45 patients had an intradermal (ID) injection given at a single site over the tumour. Both groups had isosulphan blue dye injected around the tumour. Sentinel node(s) were identified using a combination of lymphoscintigraphy, blue dye and an intra-operative hand held gamma probe. RESULTS: The preoperative lymphoscintigram (LSG) demonstrated a SLN significantly more often in the ID isotope group compared to the IP isotope group (P=0.002). A combination of blue dye and isotope successfully located the SLN in 96% of the intraparenchymal group and 100% of the intradermal group. CONCLUSION: Our results suggest that intradermal isotope injection in combination with intraparenchymal blue dye optimises the localization of the sentinel lymph node in breast cancer.     

口腔鳞癌颈部淋巴结隐匿性转移的临床病理学特点及其意义

目的:探讨口腔鳞癌颈部淋巴结隐匿性转移的临床病理学特点及其临床意义。方法:对168例口腔鳞癌未探及颈淋巴结转移的患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究,并依据临床触诊及影像学结果将淋巴结分为三组,并对比各组淋巴结转移与临床病理学特点的相关性。结果:cN0期口腔鳞癌患者颈部淋巴结隐匿性转移与年龄、原发灶的大小、病理分化及生长方式存在统计学差异（P＜0.05）;牙龈癌及颊黏膜癌原发肿瘤越大发生颈部淋巴结隐匿性转移的几率越高。临床影像学未探及肿大淋巴结组其淋巴结阳性率与原发肿瘤大小及肿瘤生长方式密切相关（P＜0.05）,影像学肿大淋巴结小于1 cm组其颈部淋巴结阳性率与原发肿瘤病理分化程度密切相关。结论:口腔鳞癌颈部淋巴结的隐匿性转移是影响患者预后的重要因素,因此,明确隐匿性转移的危险因素,对选择合理的治疗方案、判断疗效及评估预后有重要作用。     

前哨淋巴结检测对预测非小细胞肺癌淋巴结转移的价值

背景与目的:区域淋巴结的转移状态是影响非小细胞肺癌(non-smallcelllungcancer,NSCLC)预后的重要因素之一。前哨淋巴结(sentinellymphnode,SLN)检测技术提供了一种术中快速高效检测淋巴结微转移的手段,但目前SLN技术应用于NSCLC尚不成熟。本实验旨在探索NSCLC根治术中SLN检测的可行性,评价SLN预测区域淋巴结转移状态的准确性。方法:应用染料法对50例NSCLC患者在根治术中于肺肿瘤边缘分4点(3、6、9、12点处)注入异硫蓝溶液4ml,进行SLN活检识别。结果:50例NSCLC患者中共有33例找到蓝染前哨淋巴结,检出率为66.0%。SLN发生于N1淋巴结24例(72.7%)、N2淋巴结6例(18.2%)、同时发生于N1和N2淋巴结3例(9.1%)。SLN识别的灵敏度为73.3%、假阴性率为26.7%、准确率为87.9%。结论:SLN对非小细胞肺癌肺门纵隔淋巴结转移具有预测性。     

Sentinel lymph node analysis in squamous carcinoma of the oral cavity and oropharynx

AIMS: The aim of our study was to evaluate the usefulness and applicability of sentinel lymph node (SLN) identification in N0 carcinomas of the oral cavity and oropharynx. STUDY DESIGN: We carried out a prospective evaluation of SLN identification in 20 patients with oral cavity or oropharynx carcinomas with no clinical evidence of lymph node metastases. METHODS: Peritumoral infiltration with technetium-99-labeled nanocolloid followed by lymphoscintigraphy was carried out approximately 18 hours prior to surgery. A vital dye was injected intraoperatively and the SLN was identified with the aid of a gamma probe. All patients underwent routine neck dissection. RESULTS: While multiple radioactive nodes were generally identified on lymphoscintigraphy, the number of nodes ranging from one to five with variable degrees of uptake, intraoperative gamma probe scanning allowed the identification of a single more radioactive lymph node in 19 of the 20 patients. In only one patient did this method lead to the identification of two equally highly radioactive SLNs, with no uptake in the remaining nodes. All SLNs were ipsilateral to the neoplastic lesion. In 15 cases the SLN was tumor negative and so were the remaining nodes obtained by comprehensive neck dissection. In five cases the SLN was the only lymph node containing micrometastasis among those obtained by dissection. There were no instances of node positivity not involving the SLN. CONCLUSIONS: Sentinel lymph node identification in ENT surgery may indicate intraoperatively if node metastasis are present, thereby avoiding overtreatment in a substantial proportion of patients with N0 carcinomas of the oral cavity or oropharynx.     

纳米碳在子宫内膜癌前哨淋巴结检测中的应用

目的:探讨纳米碳在子宫内膜癌前哨淋巴结检测中的可行性及应用价值。方法:选择25例经手术治疗的子宫内膜癌患者,术中于子宫前壁、后壁、宫底两侧共4点处注射纳米碳混悬液,识别黑染的淋巴结,并记录前哨淋巴结相关信息,淋巴结分开单独送病理检查行HE染色。结果:25例子宫内膜癌患者均出现子宫浆膜面黑染,前哨淋巴结检出率为84%（21/25）,共计114枚,其中盆腔双侧检出率为81%,盆腔一侧检出率为19%。3例患者发生淋巴结转移,均为SLN转移。结论:纳米碳作子宫内膜癌前哨淋巴结的示踪剂具有可行性,对于子宫内膜癌淋巴结转移判断有一定的临床应用价值。