临床颈淋巴转移阴性口腔鳞癌的前哨淋巴结研究

目的探讨前哨淋巴结活检术(SLNB)在口腔鳞癌治疗中的的预测价值。方法口腔鳞癌患者20例,使用亚甲蓝染色法对前哨淋巴结进行染色识别。结果SLNB成功率为70％。SLNB对颈淋巴结微转移的检测准确率为100G。前哨淋巴结(SLN)每例平均2．4枚。14例患者中有6例存在颈部淋巴转移,其中5例仅转移至SLN,1例SLN和非SLN均有转移。结论SLNB能准确预测口腔鳞癌颈淋巴结转移情况,为SLNB阴性的口腔鳞癌患者避免颈淋巴清扫术提供了诊断依据。     

前哨淋巴结显像在口腔鳞癌分期诊断中的价值

目的 评价前哨淋巴结(SLN)显像等指导活组织检查技术(SLNB)在口腔鳞癌分期诊断中的作用.方法 Cn0期口腔癌患者31例,肿瘤旁黏膜下注射专利蓝和99Tcm-右旋糖酐(DX),分别采用蓝染法、淋巴显像法、术中γ探测法定位SLN.行常规病理检查,同时对常规切片阴性者采用连续切片,分别进行HE染色和鼠抗人角蛋白抗体(Ael/AE3)免疫组织化学检测.计算SLN的检出率及评价cNo期口腔鳞癌颈部淋巴结真实状态.结果 用蓝染法、γ探测、淋巴显像分别检测出25(80.6%),31(100.0%),30(96.8%)例的SLN,SLN分别为44,55,51枚,平均每例1.4(1～3)枚.非 SLN(NSLN)1302枚.常规病理检查SLN转移(阳性)6枚(6例),其中1例伴NSLN转移.连续切片+常规HE染色检出I例SLN转移.续切片+AE1/AE3免疫组织化学染色检出2例SLN转移.未发现单独的NSLN转移病例.结论 蓝染法、γ探测和淋巴显像对SLN均具有较高的检出率,其指导的SLNB检测可显示cN0期口腔鳞癌颈部淋巴结的真实状态;连续病理切片和AE1/AE3免疫组织化学检测有助于微小转移灶的检出.     

乳腺癌前哨淋巴结显像研究

目的　探讨乳腺癌前哨淋巴结 (SLN)显像的方法及其临床意义。方法　对 117例早期乳腺肿瘤患者进行乳腺SLN显像 ,6例进行双侧比较和SPECT CT图像融合。其中 13例在瘤体表面皮下注射99Tcm DTPA 人血清白蛋白 [HSA ,5 5 5MBq(0 5ml) ];5 0例在瘤周乳腺组织内注射未过滤99Tcm 硫胶体 [SC ,92 5MBq(4ml) ,分 4点 ];5 4例在瘤体上部乳腺组织内一点注射相同体积SC。结果　 3种方法均能快速显示SLN ,但最佳显示时间和淋巴结显示量因人而异 ,与注射深度和体积有关 ,第 3种方法能显示较多的锁骨区和内乳淋巴结。HSA、SC显像成功率分别为 6 9 2 % (30min时 )和 >84 % (2h内 )。断层图像融合有助于识别SLN和引流变异。结论　乳腺SLN显像对于正确定位SLN、识别淋巴引流变异和制定辅助治疗方案是必需的。     

探测乳腺癌前哨淋巴结的初步应用

目的 评价核素淋巴显像和γ探针定位确定乳腺癌前哨淋巴结（SLN）的价值。方法 28例妇性乳腺癌患者,体检腋窝未扪及肿块。^99Tc^m－右旋糖酐（Dx）37MBq皮下注射,行淋巴显像后用γ探针皮肤定位,并与手术、病理检查结果对照。结果 28例患者中活检的SLN26例,灵敏度为85.7%(6/7例）,特异性100％（19／19例）。结论 核素淋巴显像和γ探针定位是一种简便、安全、易被患者接受的检测SLN的方法,对预测腋窝淋巴结转移有很大帮助。     

头颈部肿瘤前哨淋巴结放射性核素探测研究进展

头颈部肿瘤前峭淋巴结是指肿瘤淋巴引流区域中的第一级淋巴结。探测头颈部肿瘤前哨淋巴结转移状况为肿瘤的准确分期和手术方案的制定提供了重要依据。放射性核素探讨可对前哨淋巴结进行显示和准确定位,检出率达90%以上,有着良好的应用前景。     

结肠癌前哨淋巴结微转移的检测

目的:探讨监测结肠癌淋巴结转移的简便而准确的方法.方法:对56例结肠癌患者应用术中染料定位的方法对其前哨淋巴结(sentinel lymph node, SLN)进行了定位,绿染的第一个淋巴结为SLN,术后从根治性切除的标本中寻找SLN.常规HE染色检查从标本中找到的SLN;对常规检查为阴性的SLN进行抗CEA免疫组化染色(SP法),寻找阳性染色的淋巴结.结果:共检出SLN130枚,每例患者的SLN为1～4枚,平均2.5枚.HE染色共发现有转移者15例,24枚,患者淋巴结转移率为27%(15/56);淋巴结阳性率为18%(24/130).免疫组化法在41例HE染色阴性的患者中又发现有30例存在微转移,微转移的发生率为73%(30/41);在HE染色阴性的106枚SLN中共有80枚免疫组化阳性,SLN微转移发生率为75.5%(80/106).结果显示免疫组化检测SLN的转移率明显高于常规HE染色(P＜0.01).结论:通过对结肠癌SLN进行术中定位,术后深入细致的病理学检测,可以在不增加病理科医生工作量的情况下明显提高对结肠癌淋巴结转移的检出率.     

应用γ探测仪探测乳腺癌前哨淋巴结的临床价值

目的 探讨应用γ探测仪探测乳腺癌前哨淋巴结活组织检查（SLNB）的临床价值。方法 53例乳腺癌患者，在肿块或活组织检查腔周围的乳腺实质内注射^99Tc^m－硫胶体，应用γ探测仪术中定位切除放射性浓聚的前哨淋巴结（SLN），再行腋窝淋巴结清扫（ALND）。SLN与腋窝淋巴结（ALN）同时行HE和免疫组织化学（IHC）检测，以及用逆转录多聚酶链反应（RT－PCR）检测CK19 mRNA的表达，观察SLN的检出率和用SLN预测ALN转移的准确性，评价SLN阴性的早期乳腺癌患者用SLNB代替ALND的可行性。结果 SLN检出灵敏度为91％（48／53例），共检出SLN91枚，平均1．9枚。SLN预测ALN转移准确性为100％，阳性预测值为0。结论 术中用γ探测仪进行乳腺癌SLNB是可行的，SLN可预测腋窝其余淋巴结的转移情况，并可作为早期乳癌患者用SLNB代替ALND的可靠指标。     

乳腺癌前哨淋巴结探查的研究进展

乳腺癌前哨淋巴结(sentinel lymph node, SLN)是乳腺癌淋巴转移通道中最先经历的第一级淋巴结。通过乳腺癌SLN预测乳腺癌区域淋巴结转移状况,为乳腺癌的准确分期和外科手术提供了重要的依据。根据示踪剂的不同,有两种方法可以探查乳腺癌SLN,其中使用放射性核素标记物作为示踪剂探查乳腺癌SLN是目前较具优势的方法,且不同于传统的淋巴显像;乳腺癌SLN探查的成功率受到诸多因素的影响,其探查技术亦需进一步的研究来提高。     

前哨淋巴结显像研究

前哨淋巴结系指原发肿瘤淋巴引流的第一级淋巴结，淋巴显像可准确定位前哨淋巴结及其数目，检出率达80%-100%，常用的前哨淋巴结显像剂有^99Tc^m-硫胶体，^99Tc^m-人血清白蛋白，^99Tc^m-右旋糖酐等，该法简便安全，实用性强，已先后应用于黑色素瘤，乳腺癌，妇科肿瘤等疾病的术前常规定位诊断，取得了很好的结果。     

前哨淋巴结显像研究

前哨淋巴结系指原发肿瘤淋巴引流的第一级淋巴结,淋巴显像可准确定位前哨淋巴结及其数目,检出率达80%~100%。常用的前哨淋巴结显像剂有99Tcm-硫胶体、99Tcm-人血清白蛋白、99Tcm-右旋糖酐等。该法简便安全、实用性强,已先后应用于黑色素瘤、乳腺癌、妇科肿瘤等疾病的术前常规定位诊断,取得了很好的结果。     

乳癌哨兵淋巴结检测临床应用

目的：探讨乳癌哨兵淋巴结活检预测腋窝淋巴结转移状态的可靠性.方法：本组为2000年11月至2004年2月我院收治的140例乳癌患者.术中应用国产亚甲蓝注射液4～6 ml肿瘤上、外、下半圆形皮下连续注射,134例行乳癌改良根治术或患侧乳腺区段切除加腋窝淋巴结清扫术.术后解剖蓝染淋巴管,沿着色淋巴管找到蓝染的哨兵淋巴结.哨兵淋巴结及腋窝淋巴结常规行石蜡病理切片检查.5例行乳腺区段切除加哨兵淋巴结活检,1例行全乳切除加哨兵淋巴结活检（冰冻、石蜡病理检查SLN转移阴性）,未行全腋窝淋巴结清扫.结果：140例患者中136例检出哨兵淋巴结,检出率97.14%,灵敏度 88.71%,准确率94.31%,阴性预测值89.71%,假阴性率11.29%,仅哨兵淋巴结阳性7例.结论：应用亚甲蓝注射液淋巴结着色方法行乳癌哨兵淋巴结活检可以准确地预测腋窝淋巴结转移状态.     

Usefulness of 3T diffusion-weighted MRI for discrimination of reactive and metastatic cervical lymph nodes in patients with oral squamous cell carcinoma: a pilot study

Objectives:

To study the diagnostic accuracy of 3T diffusion-weighted MRI (DW-MRI) for the discrimination of reactive and metastatic cervical lymph nodes in patients with oral squamous cell carcinoma.

Methods:

DW T₁ and T₂ weighted MRI was performed in 25 patients with biopsy-proved primary oral squamous cell carcinoma. The mean apparent diffusion coefficient (ADC) values of 30 histopathologically proved reactive lymph nodes and 21 histopathologically proved metastatic lymph nodes were compared using an unpaired t-test. A cut-off ADC value with optimal diagnostic sensitivity, specificity and area under the curve in discrimination of the two groups was determined using a receiver operating characteristic curve analysis.

Results:

The mean ADC values of reactive lymph node and metastatic lymph node groups were (1.037 ± 0.149) × 10⁻³ and (0.702 ± 0.197) × 10⁻³ mm² s⁻¹, respectively. A statistically significant difference in ADC values of the two groups was certified (p < 0.0001). An optimal ADC threshold value of 0.887 × 10⁻³ mm² s⁻¹ was suggested as the cut-off point, which resulted in 93.33% sensitivity, 80.95% specificity, 88.20% accuracy and area under curve of 0.887.

Conclusions:

Our preliminary study indicates that the addition of 3T DW-MRI may be useful for discriminating between reactive lymph nodes and metastatic lymph nodes in patients with oral squamous cell carcinoma. However, larger studies are still required to validate our results and to standardize this imaging technique for daily clinical practice.     

前哨淋巴结阳性乳腺癌患者腋窝转移危险因素的研究

目的研究前哨淋巴结（sentinellymphnode,SLN）阳性乳腺癌患者腋窝非前哨淋巴结（NSI-N）转移的危险因素,验证纪念斯隆一凯特琳癌症中心（MSKCC）腋窝NSLN转移预测模型评估乳腺癌患者的临床应用价值。方法回顾性地分析军事医学科学院附属医院普外科2000年,11月至2011年3月175例成功行SLN活检且结果阳性、随即行腋窝淋巴结清扫的乳腺癌患者临床病理资料,使用MSKCC预测模型计算每例患者腋窝NSLN转移风险,利用校正曲线和受试者操作特性曲线（ROC）下面积（AUC）评估该模型预测的准确性。结果原发肿瘤大小、肿瘤是否多发、阳性SLN数、阳性SLN转移率、阴性SLN数与腋窝NSLN转移相关,P值分别为0．0018、0．0029、0．0049、0．0007、0．0002。多因素Logistic回归分析发现,原发肿瘤大小、肿瘤是否多发和阳性SI．N数是NSI．N转移的独立危险因素,P值分别为0．0022、0．0160、0．0176。校正曲线显示预测值曲线和真实值曲线趋势相近,MSKCC预测模型被验证的AUC值为0．79。结论对于SLN转移阳性的乳腺癌患者,原发肿瘤越小、肿瘤单发、阳性SLN数越少、阴性SLN数越多、阳性SLN转移率越低,其腋窝NSLN转移可能性越低,可对是否行腋窝淋巴结清扣提供参考。MSKCC预测模型可较准确地预测腋窝NSI．N的转移风险。     

The lingual lymph node identified as a sentinel node on CT lymphography in a patient with cN0 squamous cell carcinoma of the tongue

We performed CT lymphography on an 81-year-old female patient with a histologically confirmed squamous cell carcinoma of the tongue with no clinical or radiological evidence of cervical lymph node involvement. The lateral lingual lymph node was identified as a sentinel node, which is the first lymph node to receive drainage from a primary tumour. CT lymphography also showed draining lymphatics passing through the sublingual space, the medial side of the submandibular gland and near the hyoid bone and connected with the middle internal jugular node. Although metastasis to the lateral lingual lymph node is known as one of the crucial events in determining survival outcome in cancer of the tongue and floor of the mouth, very few reports are available on the imaging of the lateral lingual lymph node metastasis. This is the first report regarding the lateral lingual lymph node identified as a sentinel node demonstrated on CT lymphography.     

MRI影像组学对早期口腔舌鳞状细胞癌隐匿性颈淋巴结转移的预测价值

目的:探讨基于术前常规MRI的影像组学对早期口腔舌鳞状细胞癌（OTSCC）隐匿性颈淋巴结转移的预测价值。方法:回顾性收集2015年1月至2019年12月上海交通大学医学院附属第九人民医院77例早期OTSCC患者（临床分期cT1~2N0M0）的术前MRI数据。所有患者均行原发灶切除及选择性颈淋巴结清扫术,且具有术后淋巴结...     

Assessment of the solid-state gamma camera to depict axillary sentinel lymph nodes in breast cancer patients

PURPOSE: The solid-state gamma camera is now commercially available offering the advantages of a compact and portable system, currently used mainly in the cardiac region. We evaluate the ability of the solid-state gamma camera to depict axillary sentinel lymph nodes (SLNs) in breast cancer patients. MATERIALS AND METHODS: Preoperative SLN lymphoscintigraphy (LSG) was performed in 19 patients with breast cancer using the solid-state gamma camera. Immediately thereafter, we performed a second LSG using a single detector Anger-type gamma camera, and compared the findings from the two cameras. RESULTS: Concordant results were obtained in 12 (63%) patients with both cameras. In 4 (21%) patients, axillary SLNs were correctly identified only with the solid-state gamma camera. In these patients, the distance between the SLN and the radiopharmaceutical injection site was closer than that of patients who had concordant results (p = 0.001). CONCLUSION: We can depict correctly axillary SLNs with the solid-state gamma camera in comparison with the Anger-type gamma camera. This technique would be useful for assessing SLNs in breast cancer patients.     

A preliminary study on sentinel lymph node biopsy: feasibility and predictive ability in oral cavity cancer

The main factor that affects the prognosis of patients with head and neck cancer (HNC) is regional lymph node metastases. For this reason, the accurate evaluation of neck metastases is required for neck management. This study investigates the sentinel lymph node identification and the accuracy of the histopathology of the sentinel lymph node in patients with HNC. Eleven patients with histologically proven oral squamous cell carcinoma accessible to radiocolloid injection were enrolled in this study. Using both lymphoscintigraphy and a handheld gamma probe, the sentinel lymph node could be identified in all 11 patients. Subsequently, the sentinel lymph nodes and the neck dissection specimen were examined for lymph node involvement due to tumor. The histopathology of sentinel lymph nodes was consistent with the pathological N classification in all 11 patients. Furthermore, the histopathology of sentinel lymph nodes was superior to physical examination, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scan. The results of this study indicate that sentinel lymph node identification is technically feasible and predicts cervical metastases in patients with oral cavity cancer. This may be a useful diagnostic technique for identifying lymph node disease in staging lymph node dissection.