美蓝在口腔鳞状细胞癌前哨淋巴结活检中的应用

目的：探讨美蓝在口腔鳞状细胞癌前哨淋巴结（sentinel lymphnode,SLN）活检中的应用,为临床N0患者是否作颈部淋巴结清扫提供依据。方法：用美蓝对30例口腔鳞状细胞癌临床N0患者行前哨淋巴结定位活检,通过与区域淋巴结清扫标本的比较来评价前哨淋巴结活检的准确性。结果：前哨淋巴结定位活检总成功率为93.3%（28/30）,准确率92.9%（26/28）,假阴性率为11.1%（2/18）,灵敏度为83.3%（10/12）,特异性100%（16/16）。结论：前哨淋巴结活检在口腔鳞状细胞癌中能很好地反映淋巴结的转移情况,对指导淋巴结清扫的合理性和必要性有一定的临床应用价值。     

淋巴闪烁显像法在口腔癌前哨淋巴结活检术中的应用

目的　利用淋巴闪烁显像(LS)法进行口腔癌前哨淋巴结活检术(SLNB)术前体外定位,探讨其临床应用价 值。方法　选择10例口腔癌患者,术前1 d进行LS检查,在原发灶周缘黏膜下注射核素显影剂99mTc-Dextron,进行 LS显像。术中采用染料示踪法行前哨淋巴结(SLN)定位,并行常规颈淋巴清扫术。术后对所有淋巴结进行病理学 检查。结果　10例患者中有8例于术前探查到SLN,共计10处;此8例患者术中均探测到蓝染SLN,其中8处的术 中探查结果与术前定位完全吻合。术后病理学检查此8例患者中4例淋巴结转移阳性,术前均探测到LS浓聚点。 结论　LS法术前体外定位SLN有助于SLNB在口腔癌中的应用,可作为SLNB术前的常规定位方法。     

口腔颌面癌瘤的颈淋巴结转移及颈淋巴清扫术的临床研究

目的 探讨口腔颌面癌瘤颈淋巴结转移的部分规律及其与颈淋巴清扫术间的关系。方法 对250例行颈淋巴清扫联合根治术的口腔颌面癌病例进行回顾性研究。结果 口腔颌面癌颈淋巴结转移率为18．8％，其中鳞癌的颈淋巴结转移率为23．4％，腺上皮源性癌颈淋巴结转移率为9．6％，颈淋巴结转移临床诊断与病理诊断符合率为58．4％，漏诊率为9．1％。结论 鳞状上皮细胞癌比腺上皮源性癌更易发生颈淋巴结转移；临床诊断阳性的颈淋巴结应实施颈淋巴清扫术，对N0期颈淋巴结应采取适时监测，当其转为阳性时可再行手术治疗。     

淋巴显像技术在口腔鳞癌哨位淋巴结活检中的应用

目的:评价淋巴显像技术在口腔鳞癌哨位淋巴结活检中的价值。方法:应用颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术,对21例临床NO(cNO)口腔鳞癌患者的哨位淋巴结(sentinel lymph node,SLN)进行研究。结果:全组患者SLN检出率为100％,21例中有7例SLN活检阳性,颈清术后标本同样证实有颈淋巴结转移,无假阴性结果,SLN活检对全组病例颈淋巴结转移状况预测的准确性为100％。结论:颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术能有效地对口腔鳞癌SLN进行定位,从而准确预测颈淋巴结转移状况。     

哨卫淋巴结活检作为早期口腔癌选择性颈淋巴清扫术的替代方法

Sentinel node biopsy as an alternative to elective neck dissection for staging of early oral carcinoma. Samant S, 2013 Jun 1. [Epub ahead of print] 作者报道34例临床T1／2NO的口腔癌患者哨卫淋巴结活检（SNB）的结果。在原发灶切除的同时行SNB，对病理证实的哨卫淋巴结阳性（pN＋）及SNB失败的患者行颈淋巴清扫术。结果：32（94％）例患者SNB手术成功．其余2例SNB失败患者立即行颈淋巴清扫术。7f21％）例患者pN＋，其中6例行SNB，1例行选择性颈淋巴清扫术（END）。     

半连续切片角蛋白免疫组化染色检测口腔鳞状细胞癌颈淋巴转移的精度研究

目的 探讨半连续切片角蛋白免疫组化染色检测口腔鳞状细胞癌颈淋巴转移的精度。方法 取26例接受单侧五区淋巴清扫术的原发口腔鳞状细胞癌患者的颈淋巴结1638枚，将淋巴结半连续切片，同时进行苏木素-伊红染色检测和角蛋白免疫组化检测，并比较两种检测方法的精度。结果 26例患者的1638枚淋巴结中，苏木素-伊红染色检测患者转移率80．77％（21／26），总淋巴结转移率3．17％（52／1638）；角蛋白免疫组化检测患者转移率100％．总淋巴结转移率9．89％（162／1638）；苏木素-伊红染色检测存在转移灶的52枚淋巴结，经过免疫组化检测均有转移。结论 角蛋白免疫组化检测淋巴结内的鳞状细胞癌转移灶阳性率高于常规苏木素-伊红染色检测。半连续切片的角蛋白染色能全面反应淋巴结转移的真实情况。     

708例口腔鳞状细胞癌颈淋巴转移临床病理分析

目的 探讨口腔鳞状细胞癌颈淋巴转移的规律及相关临床病理学因素。方法 对708例行颈淋巴清扫术的口腔鳞状细胞癌患者进行回顾性研究,通过单因素和多因素回归分析,寻找影响口腔鳞状细胞癌颈淋巴转移的相关临床病理学因素。采用SPSS19.0软件包对数据进行统计学分析。结果 口腔鳞状细胞癌的颈淋巴转移率为35.6%(252/708),各区的转移率分别为Ⅰ区30.7%（149/485）, Ⅱ区33.8%（164/485）,Ⅲ区22.5%（109/485）,Ⅳ区8.0%（39/485）,Ⅴ区4.9%（24/485）。在单因素分析中,年龄、肿瘤分化程度、肿瘤浸润深度、pT分级均与口腔鳞状细胞癌颈淋巴转移显著相关（P＜0.05）,而性别、原发灶部位与口腔鳞状细胞癌颈淋巴转移无显著相关性（P＞0.05）;在多因素分析中,仅肿瘤的分化程度、肿瘤的浸润深度、pT分级与口腔鳞状细胞癌颈淋巴转移有明显相关性（P＜0.05）,肿瘤浸润深度可能是口腔鳞状细胞癌发生颈淋巴转移的首要影响因素（OR=2.191）。结论 口腔鳞状细胞癌颈淋巴转移与pT分期、肿瘤浸润深度呈正相关,与肿瘤分化程度呈负相关。肿瘤浸润深度可能是口腔鳞状细胞癌颈淋巴转移的首要影响因素。     

前哨淋巴结活检对早期口腔鳞状细胞癌颈淋巴结转移诊断的Meta分析

目的 系统评价前哨淋巴结活检用于口腔鳞状细胞癌早期颈部转移诊断的临床价值.方法 检索Cochrane图书馆(cochrane library,CL)对照试验注册资料库、循证医学数据库、PubMed数据库、中国知网2001-2011年国内外关于前哨淋巴结活榆确定早期口腔鳞状细胞癌患者颈淋巴转移的文献共42篇.筛选出文献12篇,记录数据,用Meta分析的相关软件Metadisc 1.4进行统计学分析.结果 12项研究的患者共793例,最后合并的早期口腔鳞状细胞癌患者前哨淋巴结活检敏感度和特异度分别为0.86(95％可信区间:0.81 ～0.90)和0.99(95％可信区间:0.98～1.00).结论 对于早期口腔鳞状细胞癌患者前哨淋巴结活检的敏感度和特异度较高、准确率高,可以判定颈部淋巴结是否转移,以及是否需要行颈淋巴结清扫术.     

SPECT/CT同机融合显像在口腔鳞癌前哨淋巴结定位中的应用

目的　探索一种准确、实用的口腔鳞癌前哨淋巴结定位方法。方法　术前运用SPECT/CT同机融合显像技术对30例cN0期口腔鳞癌患者的SLN进行定位,术中对定位的SLN活检,术后比较SLN与颈淋巴清扫的病理结果。结果　全组病例中,SPECT/CT同机融合图像对SLN定位的准确度为100%, 8例患者的前哨淋巴结和颈清扫淋巴结病理结果证实有癌转移,前哨淋巴结活检对颈部淋巴结转移状况评价的敏感度、特异度和准确度均为100%。结论　SPECT/CT同机融合显像技术可以在术前准确定位前哨淋巴结,客观评价cN0期口腔鳞癌患者颈部淋巴结的真实状况。     

纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌颈淋巴清扫术中的应用

目的 探讨纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌患者颈淋巴清扫术中的应用价值。方法 选取96例cN0舌鳞状细胞癌患者作为研究对象,随机分为纳米炭组（试验组,50例）和对照组（46例）,其中纳米炭组患者于术前12 h在距离肿块边缘0.5 cm处黏膜下多点注射纳米炭混悬注射液（每个注射点0.1 mL,共计3~4个注射点）。根据原发肿瘤的大小及部位选择行肩胛舌骨肌上（Ⅰ~Ⅲ区）或全颈（Ⅰ~Ⅴ区）淋巴清扫术。标本离体后解剖、分离所有淋巴结,并行病理学检查,记录检获的淋巴结数目、大小、部位、病理结果。将试验组与对照组所得数据进行比较,采用SPSS 19.0统计软件包进行统计学分析。结果 31例患者行肩胛舌骨肌上颈淋巴清扫术,共检出淋巴结1 137枚,纳米炭组平均每例检出淋巴结数（43.79±19.23）枚,显著高于对照组的（30.82±8.77）枚（P=0.019）,两组均以Ⅲ区检出的淋巴结数最多,但纳米炭组Ⅱ区检出的淋巴结数及构成比均显著高于对照组（P=0.000）。65例全颈淋巴清扫术共检出淋巴结3 938枚,纳米炭组平均每例检出淋巴结数为（66.67±20.02）枚,对照组为（53.03±20.98）枚,两组差异有统计学意义（P=0.026）,两组在各区（Ⅰ~Ⅴ区）检出淋巴结数的构成比的差异无统计学意义（P=0.354）。两种颈淋巴清扫术式中,纳米炭组检出微小淋巴结的比例和检获淋巴结的准确率均高于对照组（P=0.000）;纳米炭组中染色淋巴结癌转移的检出率高于未染色的淋巴结（P=0.000）。结论 纳米炭淋巴结示踪剂可以显著提高cN0舌鳞状细胞癌患者颈淋巴清扫术中淋巴结特别是微小淋巴结的检出率,有助于提高颈淋巴清扫术的彻底性和患者临床病理分期的准确性。     

老年口腔鳞癌前哨淋巴结活检的临床病理研究

目的:探讨前哨淋巴结活检(sentinel lymph node biopsy,SLNB)预测老年口腔鳞癌患者颈部淋巴结转移的价值及提高病理准确性的方法。方法:对18例临床及影像学检查阴性的老年口腔鳞癌患者,采用1%美兰示踪定位识别前哨淋巴结,随后行全颈淋巴结清扫,将SLN做连续病理切片检查。结果:18例患者中检出SLN14例,其中13例的SLN能准确预测颈部淋巴结的转移状况。结论:应用美兰能准确定位SLN,前哨淋巴结连续病理切片活检结果,能准确预测颈部淋巴结的转移状况,具有潜在的临床应用价值。     

Challenges and outcomes in establishing a sentinel lymph node biopsy service for oral squamous cell carcinoma in a regional district specialist hospital

UK national guidelines in 2016 recommended that sentinel lymph node biopsy (SLNB) should be offered to patients with early oral squamous cell carcinoma (OSCC). We review the establishment of an OSCC SLNB service with specific consideration to resources, service implications and patient outcomes. A review of processes was performed to identify key stages in establishing the service, and subsequently a retrospective cohort study consisting of 46 consecutive patients with T1/T2 N0 OSCC was undertaken. The key stages identified were: coordinating a nuclear medicine pathway and reliable cost-appropriate pathology service, constructing a Trust business case, and gaining approval of a new interventional service policy. A median (range) of 3.3 (1-8) sentinel nodes (SLN) were removed, with 17 patients having a positive SLN. The negative predictive value of SLNB was 100%, with 12 having a SLN outside the field if elective neck dissection (END) was planned. There was a significantly increased risk of a positive SLN with increasing depth of invasion (DOI) (p=0.007) and increased diameter (p=0.036). We also identified a longer-than-ideal time to completion neck dissection and inadequate ultrasound follow up of negative SLNB patients. Establishment of a service requires careful planning. Our results were in keeping with those reported in the literature, and showed that SLNB for OSCC has a high negative predictive value and can identify at-risk SLN outside the traditional END levels, even in well-lateralised tumours. Our findings show that DOI and size of SLN were significantly associated with a positive SLN, and also identified areas requiring improvement.     

前哨淋巴结SPECT显像在老年口腔鳞癌隐匿转移中的评价

目的：探讨术前前哨淋巴结（SLN）的同位素显像（SPECT）在老年口腔鳞癌颈部隐匿转移中的诊断价值。方法：选择临床检测淋巴转移阴性的老年患者20例,肿瘤旁粘膜下注射99Tcm标记的右旋糖酐（DX）术前淋巴显像定位SLN,对SLN和非SLN采用连续病理切片行常规病理检测,对比SLN和非SLN淋巴结转移数据。结果：同位素淋巴显像法检测出17例口腔鳞癌的SLN共计36枚,平均2.3枚,SLN检测转移阳性5例,其中1例同时伴NSLN转移.未发现单独的NSLN转移。结论：同位素显像（SPECT）对前哨淋巴结（SLN）具有较高的检出率,前哨淋巴结（SLN）的检测结果可真实反映cN0期老年口腔鳞癌隐匿转移中的状况.     

Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging

Purpose

The purpose of this clinical study was to evaluate the sensitivity and specificity of cervical sentinel lymph node biopsy after mapping with indocyanine green fluorescence (ICG) for imaging early-stage oral cancer.

Diagnostic yield of sentinel lymph node biopsy in oral squamous cell carcinoma T1/T2-N0: systematic review and meta-analysis

The objective of this study was to conduct a systematic review and meta-analysis on the efficacy of sentinel lymph node biopsy (SLNB) in T1/T2-N0 oral squamous cell carcinoma (OSCC). A systematic review of the literature on SLNB until March 2019 was conducted. The review was organized according to the PRISMA protocol, considering the following PICO (population, intervention, comparison, outcome) question: What is the sensitivity of sentinel lymph node biopsy in OSCC? ‘P’ was patients with head and neck squamous cell carcinoma T1/2-N0; ‘I’ was SLNB; ‘C’ was neck treated with elective neck dissection and haematoxylin–eosin histopathology; ‘O’ was sensitivity and specificity. A meta-analysis and meta-regression were performed on the selected studies. The sensitivity of SLNB was up to 88% (95% confidence interval (CI) 72–96%) and specificity was up to 99% (95% CI 96–100%). The area under the summary receiver operating characteristic curve was 0.99 (95% CI 0.98–1.00). In the four studies where immunohistochemistry was performed, both the sensitivity and specificity were higher than in the studies without immunohistochemistry: 93% (95% CI 88–97%) and 98% (95% CI 96–100%), respectively. In conclusion, SLNB is an effective technique for treating patients with some types of stage T1/2-N0 OSCC. Some parameters such as immunohistochemistry could determine the level of diagnostic accuracy.     

Sentinel lymph node biopsy in malignant melanoma of the head and neck

Background

The aim of this retrospective study was to investigate sentinel lymph node biopsy in patients with head and neck melanoma.

Sentinel lymph node biopsies in early stage oral and oropharyngeal carcinoma: a retrospective single-centre experience

The aim of this retrospective study was to analyse a consecutive series of patients with oral and oropharyngeal carcinoma who had had sentinel lymph node biopsy (SLNB) at our hospital during 2008-2017. A total of 70 patients with clinically and radiologically confirmed primary oral (n = 67) or oropharyngeal (n = 3) carcinoma, with no signs of metastatic lymph nodes preoperatively (clinically N0) were included. Patients’ clinical and personal data, characteristics of the tumours, sentinel lymph node (SLN) status and outcomes were recorded. Eight patients had invaded SLN. Two patients with clear sentinel lymph node biopsies had recurrences in the cervical lymph nodes with no new primary tumour as origin. The negative predictive value (NPV) and sensitivity for SLNB were 97% and 80%, respectively. The depth of invasion was an individual predictor for cervical lymph node metastasis (p = 0.043). Single photo emission computed tomography (SPECT) detected fewer SLN in patients with invaded lymph nodes than in patients with clear lymph nodes (p = 0.018).Our data support the use of SLNB as a minimally invasive method for staging the cervical lymph nodes among patients with cN0 oral and oropharyngeal carcinoma. Our results further confirm that greater depth of invasion is associated with cervical lymph node metastases.     

The relative cost of sentinel lymph node biopsy in early oral cancer

IntroductionThe European Sentinel Node (SENT) trial addressed the question of the clinically lymph node negative (cN0) neck in early oral squamous cell carcinoma (OSCC). Apart from reducing neck dissection numbers, sentinel lymph node biopsy (SLNB) may reduce treatment cost. Using a treatment model derived from SENT trial information, estimates were produced of relative treatment costs between patients managed through a traditional surgical or SLNB pathway.MethodsThe model created two management approaches, the traditional surgical pathway and SLNB pathway. Using SENT trial data regarding the proportion of patients with positive, negative and false negative SLNB's a relative cost ratio (RCR) for 100 hypothetical patients passing down each pathway was generated.ResultsFrom a cohort of 481 patients, 25% had a positive SLNB, 75% a negative result and 2.5% a false negative result. Treatment of 100 hypothetical patients using the SLNB pathway is 0.35–0.60 the cost of treating the same cohort using traditional surgery techniques. Even if 100% of SLNB's are positive the SLNB approach is 0.91 of the cost of the traditional surgical approach.ConclusionThe SLNB approach appears to be cheaper relative to the traditional surgical approach, especially when extrapolated to 100 hypothetical patients.     

Sentinel lymph node biopsy for early oral cancer – accuracy and considerations in patient selection

Sentinel lymph node biopsy (SLNB) for staging oral squamous cell carcinoma (OSCC) patients presenting with early (T1 and T2 N0) disease in preference to elective neck dissection (END) remains controversial worldwide. A retrospective analysis of 145 patients who underwent sentinel lymph node biopsy for a previously untreated early oral cancer between 2010 and 2020 was performed. The primary outcome measures were predictors of occult metastases, accuracy of SLNB and disease specific plus overall survival. The negative predictive value, the false negative rate, and sensitivity for SLNB were 97%, 7.8%, and 92%, respectively. Depth of invasion (DOI) was a significant predictor of N status, overall survival, and disease specific survival. There was a significant difference in the incidence of the neck node metastasis in patients with DOI <5mm compared to those with DOI >5mm. For tumours >5mm there was a moderate to good correlation between radiological depth on contrast enhanced computed tomography (CECT) and histopathological DOI. Preoperative estimation of DOI may be a useful tool in the counselling of patients in the selection of either SLNB or END for N staging purposes in early OSCC.