非小细胞肺癌前哨淋巴结活检术的临床研究

目的探讨前哨淋巴结（sentinel lymph node,SLN）活检术在非小细胞肺癌（non small cell lung cancer,NSCLC）诊断与分期中的作用和应用可行性。方法研究对象共14例,男性10例,女性4例,平均年龄66．4岁,临床病理分期为Ⅰ—Ⅱ期,术中将4mL亚甲蓝分别等量注射于肿瘤边缘4个象限,然后均常规行肺门、纵隔淋巴结清扫术,标本送常规HE染色,病理免疫组化检查。结果14例中7例检出SLN,共24枚,阳性19枚,阳性检出率79．17％（19／24）、假阴性率20％（1／5）。结论SLN活检术在寻找有早期转移可能的淋巴结方面具有较大临床价值。     

非小细胞肺癌前哨淋巴结活检示踪技术及其临床意义研究

目的:通过比较不同示踪剂在非小细胞肺癌(non-small cell lung cancer,NSCLC)前哨淋巴结(sentinel lymph node,SLN)中的应用特点,研究SLN预测早期NSCLC区域淋巴结转移的应用价值。方法:收集我院手术切除的临床Ⅰ期NSCLC患者88例,随机分为4组,术中分别注射亚甲蓝溶液(A组,32例)、纳米碳混悬液(B组,27例)、99锝硫胶体(99 Technetium sulfur colloid,99 TcmSC)溶液(C组,17例)及亚甲蓝联合99 TcmSC(D组,12例),对肺癌SLN进行识别。常规行肺叶切除,将探测到的SLN和纵隔淋巴结分别切除。最终以病理诊断作为标准。结果:A组的SLN检出率为59.4%(19/32);B组为63.0%(17/27);C组为76.5%(13/17)和D组为91.7%(11/12)。D组显著高于前三组,P=0.042。A组SLN预测区域淋巴结转移的准确率、敏感性、阴性预测值和假阴性率分别为89.5%、66.7%、86.7%和10.5%;B组为94.1%、75.0%、92.8%和5.9%;C组为92.3%、80.0%、88.8%和7.7%,D组为100.0%、100.0%、100.0%和0。C组SLN放射性计数值为6208±3206,非SLN为1324±476,差异有统计学意义,P=0.045;D组SLN为6315±3423,非SLN为1438±537,差异有统计学意义,P=0.047。结论:染料和放射性同位素可适用于SLN检测,联合法检测SLN具有更好的可行性。SLN一定程度可反映临床早期NSCLC区域淋巴结的转移状态,有助于提高对区域淋巴结转移的准确预测。     

手术前PET-CT对非小细胞肺癌纵隔淋巴结转移的诊断价值

目的探讨术前PET-CT显像对非小细胞肺癌(NSCLC)纵隔淋巴结转移的诊断价值。方法选取2011年10月至2012年8月间进行手术根治或纵隔淋巴结活检的25例NSCLC患者。所有患者术前均行PET-CT检查,并根据手术或纵隔镜结果进行诊断及分期,计算PET-CT对诊断纵隔淋巴结的准确性、灵敏度、特异度、阳性预测值和阴性预测值。结果 25例患者中,纵隔淋巴结阳性率为28.0%。PET-CT对诊断纵隔淋巴结转移的准确性、灵敏度、特异度、阳性和阴性预测值分别为76.0%、57.1%、83.3%、57.1%和83.3%。3例假阴性患者的纵隔最大淋巴结短径分别为1.0、0.9和0.7cm。3例假阳性患者均为炎性增生。结论 PET-CT对NSCLC手术患者纵隔淋巴结转移的诊断灵敏度较低,特异度和阴性预测值较高。因此,PET-CT显示为阳性的纵隔淋巴结,有必要行纵隔镜检查;而阴性者则可不需行纵隔镜检查。     

纵隔淋巴结清除范围对Ⅰ期非小细胞肺癌患者的影响

目的:比较不同纵隔淋巴结清除范围对Ⅰ期非小细胞肺癌(NSCLC)患者生存的影响。方法:回顾性分析97例手术切除的Ⅰ期NSCLC患者临床资料,比较纵隔淋巴结清除术(SML)与纵隔淋巴结采样术(LS)对于患者生存的影响。用Kaplan-Meier曲线及Log-rank检验进行生存分析和比较,并用Cox多因素回归分析了解与生存相关的因素。结果:行SML的患者(n=28)5年生存率优于行LS的患者(n=69;84.36%vs68.54%;P=0.025)。Cox多因素分析提示,行SML是影响患者预后的因素。结论:肺叶切除加上SML能提高Ⅰ期NSCLC患者的长期生存率,可列为NSCLC的规范性术式。     

乳腺癌前哨淋巴结和非前哨淋巴结转移的影响因素分析

目的 探讨影响乳腺癌前哨淋巴结和非前哨淋巴结转移的相关因素.方法 回顾性分析2010年7月至2011年8月收治的、行前哨淋巴活检的283例女性乳腺癌患者的临床资料.结果 单因素分析结果显示,患者年龄、是否绝经、肿瘤大小、病理类型和脉管瘤栓均与前哨淋巴结转移(SLNM)有关(均P＜0.05);年龄、恶性肿瘤家族史、绝经情况、局部切除术、示踪技术、前哨淋巴结阳性、肿瘤大小、病理类型、分化程度、雌激素受体(ER)阳性、孕激素受体阳性、人表皮生长因子受体2阳性数目、脉管瘤栓和Ki-67≥15％等均与非前哨淋巴结转移无关(均P＞0.05).Logistic回归分析结果显示,患者年龄、肿瘤大小和脉管瘤栓均与SLNM有关(均P＜0.05).结论 患者年龄、肿瘤大小和脉管瘤栓是影响SLNM的独立因素,其中年龄是保护因素.而病理类型、病理分级和ER状态是否与SLNM有关存在争议.     

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

目的 探讨淋巴结清扫相关指标与完全切除的Ⅱ期(T1～2N1)非小细胞肺癌(NSCIC)患者预后的关系.方法 回顾性分析121例完全切除的Ⅱ期NSCLC患者,分析清扫的淋巴结数、N1阳性数、N2淋巴结的总数、N1淋巴结的转移度等淋巴结的临床指标对总生存率(OS)和无病生存率(DFS)的影响.结果 单因素分析显示,清扫的淋巴结数、N1淋巴结阳性数、N1淋巴结转移度和清扫N2淋巴结的总数与OS相关;多因素分析显示,清扫的淋巴结数、N1淋巴结阳性数为影响OS的独立因素.单因素分析和多因素分析均显示,肿瘤直径、清扫淋巴结总数、N1淋巴结阳性数为DFS的独立因素.结论 对于可完全切除的Ⅱ期NSCLC患者,术中至少应清扫10枚以上淋巴结.清扫淋巴结的总数≥10枚是预后的良好因素,而N1阳性淋巴结数≥3枚是预后的不良因素.     

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.     

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.     

临床Ia期非小细胞肺癌淋巴结清扫范围的探讨

背景与目的：肺癌手术中淋巴结的处理方式在学术界一直存在争论，尤其是早期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者。我们通过研究淋巴结转移规律来探讨Ia期NSCLC手术中淋巴结清扫的合理范围。方法：41例临床Ia期NSCLC患者进行肺叶切除及纵隔淋巴结系统清扫，将淋巴结行病理切片，HE染色明确是否有癌转移。研究肺门、纵隔淋巴结转移规律。结果：共清扫淋巴结295组，转移42组（占14．2％），其中肺门淋巴结转移33组。纵隔淋巴结中转移9组。纵隔淋巴结转移中第7站淋巴结出现转移4例，第5、9站淋巴结出现转移各2例，第4站淋巴结出现转移1例。上叶肿瘤转移包括5、7站淋巴结，中下叶肿瘤转移包括4、7、9站淋巴结。结论：临床Ia期非小细胞肺癌的肺门、纵隔淋巴结转移遵循区域性淋巴结引流规律，可行区域选择性淋巴结清扫，即上叶肿瘤在无肺门或隆突下淋巴结转移时可只清扫上纵隔淋巴结而无须清扫下纵隔淋巴结，中下叶肿瘤无论有无肺门或隆突下淋巴结转移都需要进行上下纵隔淋巴结清扫。     

纵隔淋巴结转移非小细胞肺癌的外科治疗

目的：总结纵隔淋巴结转移（N2）肺癌的外科治疗效果,探讨其临床病理特点与预后关系。方法：用SPSS软件对我院外科治疗1083例非小细胞肺癌建立数据库,对其中147例N2肺癌进行统计分析。结果：N2组中鳞癌发生率最低,肺鳞癌淋巴结转移度明显低于其他类型肺癌（P＜0．01）,其预后明显优于肺腺癌（P＜0．05）。根治性切除者淋巴结转移度明显低于姑息性切除者,预后明显优于姑息性切除者（P＜0．05）。淋巴结转移数与预后有关,＞4枚者预后差（P＜0．05）。手术方式及术后综合治疗与预后无明显关系。结论：肺癌外科治疗常规进行纵隔淋巴结清扫对达到根治效果和准确分期十分必要。     

非小细胞肺癌纵隔淋巴结转移规律的临床研究

目的 分析非小细胞肺癌(NSCLC)纵隔淋巴结转移规律,探讨NSCLC放射治疗靶区的勾画范围.方法 对291例NSCLC患者治疗前行纵隔CT增强扫描,分析纵隔各分区淋巴结转移的发生率,探索NSCLC纵隔淋巴结转移发生的规律.结果 152例右肺NSCLC患者中发生同侧锁骨上淋巴结转移24例,发生率15.8％,对侧锁骨上淋巴结转移10例,发生率6.6％,纵隔淋巴结转移率最高的是同侧肺门淋巴结,为59.2％,其次为4R区(56.6％)、1～2R区(36.2％)、7区(33.6％)、4L区(20.4％)、10～11L区(5.9％)、6区(3.9％)、5区(2.0％)、1～2L区(2.0％),左肺NSCLC 139例中发生同侧锁骨上淋巴结转移22例,发生率15.8％,对侧锁骨上淋巴结转移8例,发生率5.8％,纵隔淋巴结转移率最高的也是同侧肺门淋巴结,为54.0％,其次是7区(33.8％)、4R区(26.6％)、4L区(24.5％)、1～2R区(15.8％)、5区(10.8％)、6区(9.4％)、1～2L区(5.8％)、10～11R区(5.0％).结论 左右肺叶NSCLC具有不同高危纵隔淋巴结转移区域,对这些高危区域进行选择性预防照射,有助于降低复发率,提高局部控制率.     

专利蓝示踪胃癌前哨淋巴结及其微转移检测

目的探讨专利蓝示踪法检测胃癌前哨淋巴结(sentinel lymph node,SLN)的可行性和临床意义。方法34例胃癌术中病灶周围浆膜或黏膜下注入专利蓝溶液,将首先染色的淋巴结视为SLN,并进行常规病理检查和淋巴结微转移(lymphnode micro metastasis,LNMM)检测。结果胃癌SLN检测成功率为94.1%(32/34),SLN检出个数平均为1.8个/例,SLN转移率明显高于非SLN(55.1%vs14.1%),由SLN诊断胃癌区域淋巴结转移情况的准确性为93.7%(30/32),假阴性率为8.3%(2/24),2例胃癌病例因SLN的LNMM检测阳性而使病理分期上调。结论专利蓝示踪检测胃癌SLN可准确预测胃癌区域淋巴结的转移情况,并使部分胃癌淋巴结的病理分期上调。     

全胸腔镜肺癌根治术在治疗高龄患者中的价值

目的探讨全胸腔镜肺叶切除及纵隔淋巴结清扫术在治疗高龄非小细胞肺癌(non-small cell lungcancer,NSCLC)患者中的价值。方法 回顾分析225例接受该术式的NSCLC患者的临床资料,对比38例高龄(≥70岁)与随机抽取的57例非高龄(<70岁)患者的手术创伤、术后恢复、术后并发症及早期预后。结果 两组患者在手术创伤、术后恢复方面无差异;高龄组患者术后心血管并发症发生率高于非高龄组(23.7%vs 1.8%,P=0.001),其余并发症没有增多;术后生存分析两组无差异。结论 该术式治疗高龄NSCLC患者安全可行且疗效良好。     

Isolated retromammary lymph node metastasis of breast cancer without axillary lymph node involvement: a case report with a false-negative sentinel lymph node biopsy

A 54-year-old woman visited our hospital with a palpable tumor in her left breast, which was diagnosed as invasive ductal carcinoma. Breast-conserving surgery was performed, in association with a sentinel lymph node (SLN) biopsy and back-up dissection of the axillary lymph nodes. One dyed axillary lymph node with high radioactivity was defined as an SLN, and intraoperative frozen-section analysis of the SLN was negative for metastasis. The final pathological diagnosis of the tumor was invasive ductal carcinoma, and one small lymph node, located in the retromammary space, just under the tumor, was positive for metastasis. The backup axillary lymph nodes were not metastatic. This patient was diagnosed false-negative by SLN biopsy, despite being positive for retroMLN metastasis. It should be recognized that retroMLNs are difficult to detect preoperatively, or intra-operatively, using dye or radiocolloid, if they are located in the post-tumoral retro-mammary space. RetroMLNs may be a pitfall in SLN biopsies.     

乳晕下注射示踪剂行前哨淋巴结活检的可行性

目的探讨乳晕下联合注射核素和美蓝行前哨淋巴结活检的可行性。方法选择2004年10月至2007年2月早期乳腺癌患者195例，将患者抽签随机分为两组：一组将示踪剂注射在肿瘤周围（肿瘤周围组）；另一组将示踪剂注射在乳晕下（乳晕下组）。对所有患者均先行前哨淋巴结活检，再行腋窝淋巴结清扫。将所有的前哨淋巴结和非前哨淋巴结均进行常规切片和HE染色检查，对常规病理检查阴性的前哨淋巴结行多层切片和免疫组化检查。结果全组195例，肿瘤周围组98例，乳晕下组97例。肿瘤周围组与乳晕下组前哨淋巴结活检成功率分别为92．9％和97．9％（P=0．17）。经常规病理检查或多层切片加免疫组化检查后，肿瘤周围组有25例SLN阳性，乳晕下组29例SLN阳性。经腋窝淋巴结清扫后，肿瘤周围组有2例SLN为假阴性，假阴性率为7．4％（2／27），乳晕下组有3例假阴性，假阴性率为9．4％（3／32），两组间差异无统计学意义。肿瘤周围组和乳晕下组对腋窝淋巴结预测的准确度分别为97．8％和96．8％，灵敏度分别为92．6％和90．6％，差异均无统计学意义。结论乳晕下注射两种示踪剂行前哨淋巴结活检与肿瘤周围注射相比具有同样预测腋窝淋巴结状况的准确性，同时能避免肿瘤周围注射存在的缺点，是较佳的注射途径。     

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。     

乳腺癌前哨淋巴结微小转移的检测

前哨淋巴结(SLN)可以反映腋窝淋巴结的转移状况,检测SLN微小转移可以筛查出常规病理检查阴性中的高危患者,从而使治疗更加有的放矢。检测微小转移的方法有多层面切片、免疫组化染色和逆转录-聚合酶链反应(RT-PCR)。不同方法微小转移的检出率不同,其临床意义目前尚无定论；对于SLN有微小转移者,是否应清扫腋窝也在研究中。     

Axillary recurrence after negative sentinel lymph node biopsy

Background Sentinel lymph node biopsy (SLNB) has almost totally replaced axillary lymph node dissection as the first-line axillary procedure for node-negative breast cancer. SLNB has a false-negative rate of 0–22%, and regional nodal recurrence is a major concern after SLNB. In this study, we assessed axillary recurrence and risk factors in breast cancer patients 40 months after negative SLNB. Methods Of 940 patients with node-negative breast cancer who underwent SLNB between December 2003 and January 2006 at Asan Medical Center, 720 were negative on SLNB, as determined using 99-m TC radiocolloid and subareolar injection technique. Of the 720 patients negative on SLNB, 174 underwent further axillary dissection, 253 underwent node sampling, and 293 received SLNB only. Results A mean of 2.1 SLNs was removed per patient. At a median follow-up of 40 months (range 24–49 months), recurrence in the axilla was observed in three patients, all of whom had undergone SLNB only; two of these patients also had recurrences in internal mammary lymph nodes. Tumors in all three patients were hormone-receptor negative, and two were c-erbb2 negative. Conclusion The axillary recurrence rate was low in patients negative on SLNB. Negative hormone-receptor status and high nuclear grade may be risk factors for regional nodal failure after SLNB.     

早期非小细胞肺癌前哨淋巴结微转移检测的应用研究

目的 目前,尚无检测技术可准确判断肺癌前哨淋巴结(sentinel lymph node,SLN)微转移.本研究探讨CK19和MAGE A3表达与非小细胞肺癌(non-small cell lung cancer,NSCLC) SLN微转移的相关性及临床价值.方法 选择山东大学附属山东省肿瘤医院胸外科32例接受手术治疗的临床Ⅰ～ⅡA期NSCLC患者,术中联合应用染色法(异舒泛蓝溶液)和放射同位素法(99 Tc硫胶体检测)找寻SLN,并采用免疫组化技术检测SLN及非前哨淋巴结(non-sentinel lymph node,nowSLN)中CK19和MAGE-A3抗体的表达.结果 32例患者均检测出SLN,共清除淋巴结598枚,其中SLN 103枚,non-SLN 495枚.平均每例患者清除淋巴结(18.69±8.13)枚,清除SLN(3.22±1.74)枚.免疫组化法检测到20例患者44枚SLN中CK19表达阳性,19例患者31枚SLN中MAGE-A3抗体表达阳性.SLN免疫组化检查阳性率为42.72％,明显高于常规HE染色的阳性率(25.24％),P=0.01.SLN的阳性表达率与临床病理分期有关,P＜0.05;而与性别、年龄、肿瘤部位、分化程度、肿瘤大小和肿瘤类型无关,P＞0.05.结论 CK19和MAGMA3是判断淋巴结微转移较好的分子标志物,通过免疫组化技术检测SLN中CK19和MAGE-A3表达有助于评估区域淋巴结微转移状况.