腹腔镜下胃癌前哨淋巴结标示的临床应用及意义

目的：探讨腹腔镜下胃癌前哨淋巴结（SLN）检测的可行性及SLN活检预测胃周淋巴结转移状况的准确性,评价SLN活检在指导胃癌手术治疗中的应用价值。方法：2010年3—11月诊断明确的126例胃癌,在腹腔镜胃癌切除术中向肿瘤边缘正常胃壁浆膜下肌层、黏膜下层注射亚甲蓝标示SLN,腔镜下识别和切取蓝染淋巴结活检。以术后所有切除的胃周淋巴结常规病理检查结果为诊断金标准,观察SLN活检对预测胃周淋巴结有无肿瘤转移的准确性。结果：116例成功检测出SLN,检出率92．1％（116／126）。62例有淋巴结转移,其中前哨淋巴结与非前哨淋巴结（nSLN）均有转移47例,仅前哨淋巴结有转移10例,仅非前哨淋巴结有转移5例。前哨淋巴结预测胃周淋巴结转移的敏感性为91．9％（57／62）,准确率为94．0％（109／116）,假阴性率为8．1％（5／62）。结论：腹腔镜下胃癌SLN检测可行。通过SLN,术中能准确预测胃癌淋巴结转移状况,淋巴结转移阴性的胃癌患者,有望免除常规淋巴清扫。     

胃癌前哨淋巴结的临床研究胃癌前哨淋巴结的临床研究

目的：探讨胃癌前哨淋巴结（SLN）对预测各期胃癌淋巴结转移情况的意义。方法：使用美蓝-抗胃癌单克隆抗体MAb 3H11，对120例胃癌术中及术后前哨淋巴结定位和活检。结果：119例找到胃癌SLN为转移淋巴结，其中8例为唯一转移部位；55例SLN为非转移淋巴结，其中5例非前哨淋巴结存在转移。SLN预测胃周淋巴结转移的敏感性为92．8％，假阴性率为7．3％，准确率为95．8％。T1期敏感性100％，准确率100％；T2期敏感性96．3％，准确率97．9％；T3期敏感性为89．7％，准确率92．3％，假阴性率10．3％。结论：胃癌SLN定位及活检技术能较准确反映早期胃癌的淋巴结转移状况。     

乳腺癌新辅助化疗后前哨淋巴结活检的初步研究

目的研究乳腺癌新辅助化疗后前哨淋巴结活检（SLNB）的可行性和效果。方法利用新型示踪剂——^99mTc-利妥昔配合专利蓝染料对60例原发性乳腺癌新辅助化疗后病例进行SLNB，并对SLN进行常规病理检查和免疫组织化学检查。SLNB后常规腋窝淋巴结清扫。结果SLN检测成功率95％（57／60）。SLN转移阳性23例（40％），其中18例为常规病理检查转移阳性（78％），5例为免疫组织化学检出的微转移（22％）。23例SLN有转移病例中，9例同时存在其他腋窝淋巴结转移，另外14例为惟一转移淋巴结。1例SLN转移假阴性。灵敏度96％（23／24），准确性98％（56／57），特异度100％（33／33），假阴性率4．3％（1／23），阴性预测值97％（36／37），阳性预测值100％（24／24）。内乳淋巴结显像11例，活检病理检查均为转移阴性。结论同位素示踪剂和蓝染料联合检测方法对原发性乳腺癌新辅助化疗后进行SLNB同样适用，内乳前哨淋巴结活检不应做常规推荐。     

新型示踪剂99mTc-利妥昔用于原发性乳腺癌前哨淋巴结活检的初步研究

目的 探讨新型示踪剂^99mTc-利妥昔用于原发性乳腺癌前哨淋巴结活检（SLNB）的可行性和效果。方法 采用^99mTc-利妥昔配合染料专利蓝对85例原发性乳腺癌进行前哨淋巴结活检,并对前哨淋巴结（SLN）进行常规病理检查和以细胞角蛋白19为标志物的免疫组化检查,以确定有无SLN转移。结果^99mTc-利妥昔联合专利蓝检测SLN,检测成功率为96％（82／85）。SLN转移阳性30例（37％,30／82）,其中24例（80％,24／30）常规病理检查为转移阳性,6例（20％,6／30）为免疫组化检出的微转移。30例SLN有转移患者中,12例同时存在其他腋下淋巴结转移,18例为惟一转移淋巴结。1例SLN转移假阴性。灵敏度为97％（30／31）,特异度为100％（51／51）,准确度为99％（81／82）,假阴性率为3％（1／30）,阴性预测值为98％（51／52）,阳性预测值为100％（31／31）。内乳淋巴结显像11例,活检病理检查均为转移阴性。结论 ^99mTc-利妥昔可使SLN显像持久,有利于SLNB的时间选择;^99mTc-利妥昔联合专利蓝行SLNB的准确率、敏感度较高。     

美蓝染色法检测乳腺癌前哨淋巴结的临床研究

目的 寻找检测乳腺癌前哨淋巴结(SLN)方法，研究前哨淋巴结活检(SLNB)预测腋窝淋巴结状况的准确性。方法 对40例乳腺癌患者行美蓝染色法检测SLN，并行腋窝淋巴结清扫术(ALND)后，将腋窝淋巴结转移状况与SLN进行对比分析，分析SLN检出率及临床特征。结果 40例患者中成功检测出SLN35例，成功率为87．5％。检出SLN60个，平均每例检出SLNl．7个。2例出现假阴性，假阴性率为10.5％，无假阳性。35例患者中有16例SLN阳性，阳性率为45.7％。SLNB预测腋窝淋巴结(ALN)的敏感性为88．8％，特异性为100％，准确性为94．4％。结论 美蓝染色法检测乳腺癌SLN经济实用，可以较准确地预测腋窝淋巴结的转移状况。     

乳腔镜前哨淋巴结活检术的临床应用

目的 探讨经乳腔镜前哨淋巴结活检的可行性及应用前景。方法 应用亚甲蓝染色法检测62例乳腺癌患者的前哨淋巴结(SLN)。在乳腔镜下切除SLN,随后行乳腔镜腋窝淋巴结清扫,SLN、腋窝淋巴结同时行HE染色,评价SLN检出率及假阴性率。结果 62例患者61例检出前哨淋巴结,成功率98．4％。无腋窝淋巴结转移者35例,转移27例,假阴性率0。结论 乳腔镜前哨淋巴结活检检出率高,美容效果好,并发症低,对于乳腺癌腋窝淋巴结转移有较高的敏感性,可以为绝大多数乳腺癌进行准确淋巴分期。     

胃癌前哨淋巴结术中定位和病理学检查

目的探讨肿瘤前哨淋巴结(SLN)活检技术在胃癌诊疗中应用的可行性。方法将38例胃癌患者,按肿瘤浸润深度分组,用术中注射美蓝的方法定位前哨淋巴结,用细胞角蛋白(CK-19)免疫组织化学染色判断淋巴结转移情况。结果38例患者全部检出SLN(100%)。出现淋巴结转移的有18例,其中SLN出现转移的有15例。SLN预测淋巴结癌转移的敏感性、假阴性率和准确率分别为83.3%、16.7%和92.1%;胃癌T1组无SLN假阴性者,准确率100%;T2组有1例假阴性者,准确率94.1%;T3组假阴性2例,准确率6/8例。结论采用肿瘤周围注射亚甲蓝的方法术中定位淋巴结为可行的SLN术中定位方法。     

乳腺癌前哨淋巴结检测的临床研究

目的通过前哨淋巴结(sentinel lymph node,SLN)活检,了解前哨淋巴结是否能反映乳腺癌腋窝淋巴结转移情况,从而决定是否行腋窝淋巴结清扫(axillary lymph node dissection,ALND). 方法 47例T1、T2、T3临床检查腋窝淋巴结无肿大的乳腺癌患者,术前30 min于乳腺肿块周围腺体注射蓝色染料,术中取蓝染的SLN病理检查,术后将病理检查结果与腋窝淋巴结转移情况进行比较分析. 结果 47例中5例未见淋巴结及淋巴管蓝染,其余42例找到腋窝淋巴结608个,阳性18例168个,阴性24例440个;SLN共78个,阳性16例29个,阴性26例49个.SLN的检出率89.4%,准确性95.2% ,特异性100%,敏感性88.9%,假阴性率11.1%,假阳性率0. 结论 SLN活检反应腋窝淋巴结的肿瘤转移状况,可以用于术中确定是否行ALND.     

乳腺癌前哨淋巴结活检对腋窝淋巴结转移的预警价值研究

目的探讨乳腺癌前哨淋巴结(sentinel lymph node,SLN)预警腋窝淋巴结转移的价值. 方法对56例乳腺癌行亚甲蓝前哨淋巴结定位、活检和腋窝淋巴结清扫术,标本常规行HE染色、免疫组化病理检查. 结果 SLN成功检出52例(52/56,92.8%),常规病理检查证实SLN转移22例;SLN无转移,但非SLN发现转移者1例,假阴性率为4.3%(1/23).常规病理检查无转移的29例患者,免疫组化检测发现1例CK-19( )、EMA( ),另1例CK-19( ),CEA( ),而所属非前哨淋巴结无肿瘤转移. 结论乳腺癌亚甲蓝前哨淋巴结定位、活检可以预示腋窝淋巴结转移.     

可切除胃癌的前哨淋巴结示踪研究

目的 探讨前哨淋巴结活检在胃癌中的临床价值.方法 回顾性分析2003年1月至2006年6月46例行D2根治术的胃癌患者进行亚甲蓝前哨淋巴结活检的临床资料.结果 38例成功识别前哨淋巴结.前哨淋巴结敏感性、假阴性、准确性、特异性、阴性预测值及阳性预测值分别为69%(18/26)、31%(8/26)、79%(30/38)、100%(12/12)、60%(12/20)、100%(12/12).pT1期、TNM Ⅰ期和肿瘤直径<4 cm的患者,敏感性、准确性和阴性预测值均高达100%.肿瘤部位和淋巴结转移程度影响活检成功率,而肿瘤浸润深度、临床分期、淋巴结转移程度影响活检的敏感性、准确性和阴性预测值.结论 亚甲蓝前哨淋巴结活检在胃癌中的应用是可行的,早期患者的敏感性、准确性和可靠性高.     

腹腔镜下前哨淋巴结检测在早期宫颈癌中的应用

目的探讨早期宫颈癌腹腔镜下前哨淋巴结（Sentinel lymph node,SLN）检测的可行性及前哨淋巴结活检预测盆腔淋巴结转移状况的准确性,评价SLN活检在早期宫颈癌中的应用价值。方法选择诊断明确的早期宫颈癌患者26例,采用腹腔镜下广泛子宫切除术和盆腔淋巴结清扫术,术中从宫颈分4点注射1%亚甲蓝染料4ml行淋巴绘图,腹腔镜下识别和取蓝染淋巴结活检。蓝染淋巴结和手术的其他标本分别送病理检查,常规石蜡包埋切片、HE染色,以手术后所有切除的盆腔淋巴结常规HE染色病理检查结果为诊断金标准,观察SLN活检对预测盆腔淋巴结有无肿瘤转移的准确性、假阴性率等及SLN分布情况。结果26例宫颈癌中,23例成功检测出SLN,检出率为88.5%（23/26）。共检出SLN51枚,其中1个SLN者6例,2个SLN者9例,3个SLN者6例,4个SLN者1例,5个SLN者1例。双侧分布者占65.2%（15/23）。26例中,5例（19.2%）盆腔淋巴结有转移。23例SLN成功识别的患者中,3例（6枚）SLN存在转移。SLN转移且盆腔淋巴结有转移者2例,SLN是盆腔淋巴结唯一转移者1例,SLN无转移而盆腔淋巴结有转移者1例。SLN活检预测盆腔淋巴结的准确性为95.7%（22/23）,灵敏度为75%（3/4）,特异度为100%（19/19）,阴性预测值为95%（19/20）,SLN与盆腔淋巴结的转移有极好的一致性（κ=0.832）。结论采用腹腔镜技术可以较准确地检测出SLN,可以用于早期宫颈癌SLN活检;SLN能较准确地反映区域淋巴结的转移状况。     

前哨淋巴结导航手术在早期胃癌治疗中的初步应用

目的 探讨早期胃癌(EGC)在前哨淋巴结(SLN)导航下行缩小手术的可行性和临床意义.方法 将确诊的39例EGC患者随机分为SLN导航组(20例)和常规手术组(19例).导航组联用专利蓝和99m>Tc标记的硫胶体进行SLN活检,对17例SLN术中冰冻病理阴性的EGC行缩小的D0-D1病灶局部切除或胃部分切除术,余3例因SLN阳性行常规D2根治术.传统手术组19例均行D2根治术.计算SLN诊断EGC淋巴结转移情况的准确率和假阴性率,比较两组的手术情况、术后康复和1、3年无瘤生存率.结果 SLN检测成功率为100%(20/20),平均检出SLN 2.2个/例,由SLN诊断胃癌区域淋巴结转移状况的准确性为95%(19/20),假阴性率为5%(1/20).与22例传统手术相比,17例缩小手术在不降低术后无瘤生存率的前提下,显著缩短了手术时间,减少了术中出血量,加快了术后康复的速度,减少了手术并发症.结论 SLN活检可准确判断EGC的区域淋巴结转移情况,对SLN转移阴性的EGC病例行缩小的限制性手术既可保证根治效果又能获得微创益处.     

Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. For the University of Louisville Breast Cancer Study Group

INTRODUCTION: Multiple radioactive lymph nodes are often removed during the course of sentinel lymph node (SLN) biopsy for breast cancer when both blue dye and radioactive colloid injection are used. Some of the less radioactive lymph nodes are second echelon nodes, not true SLNs. The purpose of this analysis was to determine whether harvesting these less radioactive nodes, in addition to the "hottest" SLNs, reduces the false-negative rate. METHODS: Patients were enrolled in this multicenter (121 surgeons) prospective, institutional review board-approved study after informed consent was obtained. Patients with clinical stage T1-2, N0, M0 invasive breast cancer were eligible. This analysis includes all patients who underwent axillary SLN biopsy with the use of an injection of both isosulfan blue dye and radioactive colloid. The protocol specified that all blue nodes and all nodes with 10% or more of the ex vivo count of the hottest node should be removed and designated SLNs. All patients underwent completion level I/II axillary dissection. RESULTS: SLNs were identified in 672 of 758 patients (89%). Of the patients with SLNs identified, 403 patients (60%) had more than 1 SLN removed (mean, 1.96 SLN/patient) and 207 patients (31%) had nodal metastases. The use of filtered or unfiltered technetium sulfur colloid had no impact on the number of SLNs identified. Overall, 33% of histologically positive SLNs had no evidence of blue dye staining. Of those patients with multiple SLNs removed, histologically positive SLNs were found in 130 patients. In 15 of these 130 patients (11.5%), the hottest SLN was negative when a less radioactive node was positive for tumor. If only the hottest node had been removed, the false-negative rate would have been 13.0% versus 5.8% when all nodes with 10% or more of the ex vivo count of the hottest node were removed (P =.01). CONCLUSIONS: These data support the policy that all blue nodes and all nodes with 10% or more of the ex vivo count of the hottest SLN should be harvested for optimal nodal staging.     

Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer

OBJECTIVE: The aim of this study was to determine the feasibility of sentinel lymph node (SLN) biopsy in patients with gastric cancer for the assessment of regional lymph node status. SUMMARY BACKGROUND DATA: SLN is the first draining node from the primary lesion, and it is the first site of lymph node metastasis in malignancy. SLN mapping and biopsy are of great significance in the determination of the extent of lymphadenectomy, allowing patients with gastric cancer to have a better quality of life without jeopardizing survival. METHODS: The SLN biopsy was performed in 46 consecutive patients having gastric cancer with a preoperative imaging stage of T1/T2, N0, or M0. Three hours prior to each operation, Tc tin colloid (2.0 mL, 1.0 mCi) was endoscopically injected into the gastric submucosa around the primary tumor. Subsequently, serial lymphoscintigraphy was performed using a dual-head gamma camera. After the SLN biopsy had been performed using a gamma probe, all patients underwent radical gastrectomy (D2 or D2+alpha). The SLN was cut and immediately frozen-sectioned. A paraffin block was then produced for permanent hematoxylin-eosin staining and immunohistochemistry (IHC). RESULTS: SLNs were successfully identified in 43 of 46 patients (success rate, 93.5%). On average, 2 (range, 1-8) SLNs were identified per patient. The positive predictive value, negative predictive value, sensitivity, and specificity of SLN biopsy were 100% (11 of 11), 93.8% (30 of 32), 84.6% (11 of 13), and 100% (30 of 30), respectively. SLNs were located at the level I lymph nodes in 38 (88.4%), the level I+II nodes in 2 (4.7%), and the level II nodes in 3 (7.0%). No micrometastases of SLNs was found on IHC for cytokeratin. CONCLUSIONS: SLN biopsy using a radioisotope in patients with gastric cancer is a technically feasible and accurate technique, and it is a minimally invasive approach in the assessment of patient nodal status.     

Sentinel Lymph Node Evaluation Does Not Improve Staging Accuracy in Colon Cancer

BACKGROUND: Lymph node involvement is an important prognostic factor in colorectal cancer. Sentinel lymph node (SLN) evaluation for assessing lymph node status in colorectal cancer remains controversial. Here we evaluated the sensitivity, predictive value, and accuracy of SLN evaluation for determining lymph node status in resectable colon cancer. METHODS: A prospective phase 2 cohort study of SLN evaluation in colon cancer was conducted from September 1998 to April 2006. Patients underwent resection and SLN mapping with 1% isosulfan blue and (m99)Tc sulfur colloid injection. SLNs were evaluated by hematoxylin and eosin (HE) staining and, if findings were negative, by additional thin HE sections and immunohistochemical (IHC) staining for pancytokeratin and MOC31. Overall survival for patients with IHC-positive disease was evaluated by Kaplan-Meier analysis and the log rank test. RESULTS: SLNs were identified in 119 (99%) of the 120 patients eligible for the study. Median number of SLNs identified was 4 (range, 0-13). Forty-nine patients (40%) had nodal metastases on HE. The SLN accurately identified nodal metastases in 29 (59%) of these 49 patients and was negative for metastases in 22 patients (41%). SLNs in eight patients (7%) were negative by HE but positive by IHC staining. Positive IHC status did not affect survival after a median follow-up of 33 months (P = .41). CONCLUSIONS: The low sensitivity and high false-negative rate of SLN evaluation does not support this technique for improving the accuracy of nodal staging for patients with colon cancer. The significance of IHC-positive SLNs remains uncertain.     

结直肠癌前哨淋巴结体外标记的研究

目的探讨结直肠癌前哨淋巴结（SEN）体外亚甲蓝定位活检方法的可行性，研究前哨淋巴结组织学状况能否用于预测区域淋巴结转移情况。方法将32例手术切除的结直肠癌标本纵行剪开，在癌肿四周注射亚甲蓝，2—5min后沿着蓝染的淋巴管追踪寻找首先蓝染的前哨淋巴结。将其切下后单独进行病理切片，检测有无癌转移，并与系膜淋巴结病理结果予以比较。结果有30例标本成功显示57枚SLN，平均每例标本显示1．9枚SLN。在SLN阳性的13例患者中。5例非SLN呈阳性，8例非SLN呈阴性；在17例SLN为阴性的标本中，15例非SLN呈阴性，仅2例非SLN呈阳性。统计本组患者SLN标记成功率为93．8％（30／32），准确率为93．3％（28／30），假阴性率为11．8％（2／17），特异性为100％（13／13）。结论结直肠癌标本前哨淋巴结体外亚甲蓝标记法可行，其组织学状况可较准确反映区域淋巴结群的癌转移情况。     

Sentinel node biopsy to evaluate the metastatic dissemination of oesophageal adenocarcinoma

BACKGROUND: The aim of this study was to determine the feasibility and accuracy of sentinel lymph node (SLN) biopsy for oesophageal adenocarcinoma. METHODS: Fifty-seven patients with adenocarcinoma of the lower oesophagus (n = 40) or gastric cardia (n = 17) underwent endoscopic peritumoral injection of (99m)Tc-radiolabelled nanocolloid before en bloc resection with extended lymphadenectomy. SLNs were identified during surgery using a handheld gamma probe and the pattern of radioactive uptake was quantified after operation. All 1667 resected lymph nodes were examined immunohistochemically for micrometastases. RESULTS: SLNs were identified in all 57 patients. They contained metastases (n = 32) or micrometastases (n = 3) in 35 of 37 node-positive patients and there were two false-negative studies. The overall accuracy of SLN biopsy was 96 per cent and SLNs were more likely to contain tumour than other lymph nodes (P < 0.001). Tumour-infiltrated nodal stations had a higher proportion of radioactive uptake (P < 0.001). Lower oesophageal tumours had a greater proportion of SLNs (P = 0.018), radioactive uptake (P < 0.001) and malignant nodes (P = 0.004) in the mediastinum than gastric cardia tumours. CONCLUSION: The sentinel node concept is applicable to oesophageal adenocarcinoma and could be used to tailor the extent of lymphadenectomy. There is a close relationship between patterns of radioactive uptake and lymphatic tumour dissemination, which differ for lower oesophageal and gastric cardia tumours.     

Sentinel lymph node biopsy in breast cancer: an analysis of the maximum number of nodes requiring excision

Sentinel lymph node biopsy (SNB) is now the standard of care in assessment of patients with clinically staged T1-2, N0 breast cancers. This study investigates whether there is a maximum number of sentinel lymph nodes (SLN) that need to be excised without compromising the false-negative (FN) rate of this procedure. Data were prospectively collected for 319 patients undergoing SNB between February 2001 and December 2006 at our institution. This data were analysed, both in terms of the order of SLN retrieval and relative isotope counts of the SLNs, in order to determine the maximum number of SLNs that need to be retrieved without increasing the FN rate. Furthermore, we investigated the relationship between SLN blue dye concentration and the presence of SLN metastases. The SLN identification rate was 97% with no false-negative cases amongst patients undergoing simultaneous axillary clearance historically during technique validation. In patients with SLN metastases, excision of the first 4 SLNs encountered results in the identification of a metastatic SLN in all cases. Although the majority (86%) of SNB metastases are in the hottest node, the SLN containing the metastasis is in the first 4 hottest nodes in 99% of patients with nodal metastases. The remaining 1% of SLN metastases were identified by blue dye. There was no statistically significant association between the SLN blue dye concentration and the presence of SLN metastases. A policy to remove a maximum of four blue and/or hot SLNs along with any palpably abnormal lymph nodes does not result in an increased false-negative rate of detection of SLN metastases.