甲状腺癌前哨淋巴结活检及其临床意义

前哨淋巴结的定义是引流肿瘤部位区域淋巴系统的第一枚淋巴结,将其显示后切除活检,以判断区域淋巴结有无转移。即前哨淋巴结活检技术（sentinel lymph node biopsy,SLNB）。Cabanas于1977年首先用于阴茎癌100例,提出若前哨淋巴结阴性可免于淋巴结清扫。随后,Morton将其用于黑色素瘤的处理。     

甲状腺癌前哨淋巴结活检的研究进展(文献综述)

前哨淋巴结活检术 (SLNB)是一项新兴技术 ,在乳头状和滤泡状甲状腺癌的诊治中 ,SLNB的技术方法、适用性及诊断价值综述如下 :( 1 )方法 :染色法、同位素法、联合法 ;( 2 )SLN的检出率平均为 91 %( 66%～ 1 0 0 %) ,准确率为 80 %～ 1 0 0 %。误检误诊原因为甲状旁腺染色 ,SLN位于纵隔及甲状腺内同位素对SLN定位的干扰 ;( 3 )SLNB在甲状腺癌的应用是可行的 ,并具有重要意义     

甲状腺癌前哨淋巴结活检的研究进展（文献综述）

前哨淋巴结活检术(SLNB)是一项新兴技术，在乳头状和滤泡状甲状腺癌的诊治中，SLNB的技术方法、适用性及诊断价值综述如下：(1)方法：染色法、同位素法、联合法；(2)SLN的检出率平均为91％(66％～100％)，准确率为80％～100％。误检误诊原因为甲状旁腺染色，SLN位于纵隔及甲状腺内同位素对SLN定位的干扰；(3)SLNB在甲状腺癌的应用是可行的，并具有重要意义。     

乳腺癌前哨淋巴结活检的初步体会

目的 初步探讨乳腺癌前哨淋巴结（sentinel lymph node,SLN)检测的可行性,SLN预测腋窝淋巴结状态的可靠性。方法 对我院普外科收治的15例T1-2期、腋窝未扪及肿大淋巴结的乳腺癌病人,使用^99mTc右旋糖酐或^99mTc硫胶体为示踪剂,γ探测仪探测SLN,然后进行活检和腋窝淋巴结清扫（axillary lymph node dissection,ALND)。两处标本同时送病理检查,以此来评价SLN的病理组织学结果能否准确地反映腋窝淋巴结状态。结果 在10例病人中发现SLN,发现率为66.6%(10/15),SLN的数量为1-3枚/例,平均2.1枚/例,非前哨淋巴结（non-sentinel lymph node,NSLN)5-16枚/例,平均10.3枚/例,发现SLN的10例病人中1例（10%）SLN有癌转移,其他腋窝淋巴结未见转移;2例SLN未发现癌转移而NSLN有癌转移,假阴性率20%（2/10）,准确性80%（8/10）,结论 乳腺癌前哨淋巴结定位和活检技术以及预测腋窝淋巴结状态的可靠性方面有待进一步积累经验,提高准确性,降低假阴性率。     

乳腺癌前哨淋巴结活检

18 94年 ,美国医生Halsted首创了乳腺癌根治术 ,使术后复发率由当时的 5 8%～ 85 %下降到 6% ,开创了肿瘤器官整块广泛切除和区域淋巴结清扫的经典肿瘤外科治疗原则。 2 0世纪 70年代 ,美国学者Fisher提出乳腺癌是一种全身性疾病 ,区域淋巴结并非癌细胞滤过的有效屏障 ,血流扩散更具重要意义的理论后 ,乳腺癌手术逐步向保乳手术迅速发展。近年来 ,不少学者对乳腺癌常规行腋淋巴结清扫 (axillarylymphnodedissection ,ALND)这一金标准的必要性提出质疑 ,引发了乳腺癌外科治疗的又一次革命[1] 。近期不断有资料显示 ,较小范围的腋淋巴结切…     

前哨淋巴结活检和乳腺癌

前哨淋巴结活检目前正成为乳腺癌外科治疗的研究热点，本文将对其最新的发展进行综述。     

乳腺癌前哨淋巴结活检的研究进展

目的 报道乳腺癌前哨淋巴结活检的研究进展。方法 采用文献回顾的方法，对国外乳腺癌前哨淋巴结活检的历史、概念、活检技术以及临床应用等问题进行综述。结果 乳腺癌前哨淋巴结活检的操作方法还没有统一的标准，检出率及假阴性率变化范围广。结论 前哨淋巴结活检的临床应用还需要大量前瞻性多中心随机实验结果进一步论证。     

乳腺癌前哨淋巴结的定位与活检

目的 探讨乳腺癌前哨淋巴结定位与活检技术的可行性和前哨淋巴结能否准确预告腋淋巴结状况。方法 应用美蓝对32例乳腺癌患者进行术中及术后前哨淋巴结定位与活检。结果 26例（81.25%)检出前哨淋巴结，且均集中在levelⅠ区域，用美蓝定位前哨淋巴结预告腋淋巴结转移的敏感性为77.78%(7/9)。准确性为80.77%(21/26)。特异性为82.35%(14/17)，假阴性率为22.22%(2/9)。结论 前哨淋巴结虽能预测腋淋巴结状态，但要取代腋淋巴结清扫还需进一步研究。     

前哨淋巴结活检

1977年Ｃａｂａｎａｓ最先提出接受肿瘤引流的第 1个淋巴结称为前哨淋巴结 (ｓｅｎｔｉｎｅｌｎｏｄｅ ,ＳＮ) ,应在一定范围内将其切除进行病理学检查 ,以确定是否需进行更广泛的淋巴结清扫[1] 。从理论上讲 ,由于ＳＮ是接受肿瘤引流的第 1个淋巴结 ,应该最先反映肿瘤的转移情况 ,因而是进行组织病理学检查最好的淋巴结[2 ] 。目前 ,前哨淋巴结活检 (ｓｅｎｔｉｎｅｌｎｏｄｅｂｉｏｐｓｙ ,ＳＮＢ)主要用于乳腺癌和恶性黑色素瘤的淋巴结检查。一、前哨淋巴结活检的意义近百余年来 ,乳腺癌手术加腋窝淋巴结清扫 (ａｘｉｌｌａｒｙｌｙｍｐ…     

前哨淋巴结活检在早期胃癌淋巴结转移评估中的应用

1977年,Cubanas在对阴茎癌的研究中,首先提出了前哨淋巴结（sentinel lymph node,SLN）的概念。1992年,Morton将染色剂注入黑色素瘤体后,发现染色剂从原发肿瘤经淋巴管流入第1站淋巴结。通过对恶性黑色素瘤和乳腺癌病人的研究,人们给SLN下了以下定义,即最先接受原发肿瘤淋巴引流的淋巴结和首先可能发生微转移的一个或一组淋巴结。如果SLN阴性则其他区域淋巴结也较少发生转移,因此SLN的检测结果可作为是否行淋巴结清扫的依据。     

胃癌根治术中前哨淋巴结活检的可行性研究

目的研究前哨淋巴结活检(SLNB)技术是否可以应用于胃癌根治术中。方法筛选符合实施SLNB条件的胃癌患者;实施SLNB;标记前哨淋巴结(SLN);行规范性胃癌根治术;对SLN、非前哨淋巴结(n-SLN)和切除的胃癌组织采用常规HE染色法进行病理检查。结果76例胃癌患者行SLNB,有66例检到SLN,成功率为86.84%(66/76)。在66例SLNB成功的胃癌患者中有35例常规病理检查阳性,31例阴性。在31例阴性患者中,有13例区域淋巴结检测为阳性即假阴性,假阴性率为27.10%(13/48),余18例区域淋巴结检测也呈阴性即真阴性,SLNB对于区域淋巴结预测的准确性是80.30%(53/66),敏感性是72.90%(35/48),特异性为100.00%(18/18)。结论SLNB技术可以应用于T1、T2期胃癌根治术中。     

Role of sentinel lymph node biopsy for oral squamous cell carcinoma: Current evidence and future challenges

Sentinel lymph node biopsy (SLNB) has been used across oncological specialties for prognostication, staging, and identification of occult nodal metastasis. Recent studies demonstrated the potential clinical utility of SLNB in oral cavity squamous cell carcinoma (OCSCC). Elective neck dissection is the current standard of care in early management of OCSCC with depth of invasion greater than 2–4 mm; however, majority of patients ultimately do not have nodal disease on final pathology. SLNB is an alternative procedure widely adopted in early cancer management in many oncological subspecialities. Several considerations such as depth of invasion, nodal mapping, histopathology methods, operator variability, postoperative complications, and advancement in preoperative and intraoperative imaging technology can guide the appropriate application to SLNB in OCSCC. The aim of this review is to discuss the current evidence for SLNB in the treatment of early stage OCSCC, imaging technologies that support SLNB procedures, and studies that are currently underway.     

Evaluation of the benefit of using blue dye in addition to radioisotope for sentinel lymph node biopsy in patients with breast cancer

The techniques for performing sentinel lymph node biopsy (SLNB) vary from institution to institution. Some advocate blue dye only, others radioisotope only, and many utilize a combination of both. The purpose of this study is to evaluate the additional benefit that blue dye provides when used in combination with a radioisotope. From October 2001 to June 2004, 102 SLNBs were attempted in 99 patients with breast cancer using a combination of blue dye and radioisotope. A lymph node was considered a sentinel lymph node (SLN) when it was stained with blue dye, had a blue lymphatic afferent, or had increased radioactivity. Ninety-eight patients had 101 successful identifications of SLNs, for an identification rate of 99%. Twenty-eight patients had positive SLNs. In three of those patients, although there were SLNs identified by both techniques, the positive SLNs were identified with only blue dye. Of the 102 SLNB procedures, there were two patients whose only SLN was identified by blue dye only. Although blue dye did not improve the identification rate, there was a definite benefit in improving the false-negative rate.     

甲状腺球蛋白在评估分化型甲状腺癌淋巴结转移中的研究进展

目的探讨甲状腺球蛋白对分化型甲状腺癌治疗及随访过程中淋巴结转移的评估价值。方法通过在线数据库收集国内外有关甲状腺球蛋白评估分化型甲状腺癌淋巴结转移的文献,并分类归纳进行综述。结果甲状腺球蛋白的测定对于分化型甲状腺癌淋巴结转移患者的围手术期评估、术后转移灶放射性治疗的指引以及复发转移的监测都有着重要的作用,并且联合影像学检查更能提高其评估效能。结论甲状腺球蛋白是分化型甲状腺癌治疗及随访过程中评估淋巴结转移的重要标志物,联合影像学和其他实验室指标综合探究其诊断阈值是完善其评估淋巴结转移价值的新思路。     

乳腺癌前哨淋巴结活检的临床应用研究

目的探讨乳腺癌前哨淋巴结活检术（SLNB）在临床应用中的价值。方法应用亚甲蓝染色法对58例乳腺癌患者先行SLNB,随后行乳腺癌常规外科手术。结果58例患者中前哨淋巴结（SLN）检出率为93．1％,准确率为96．3％。假阴性率为5．71％,假阳性率为0;操作者的学习曲线、患者的年龄、原发肿瘤的部位影响SLN的检出率（P〈0．05）;肿瘤的大小、病理类型不影响SLN的检出率（P〉0．05）。结论乳腺癌SLNB能够准确地预测乳腺癌患者腋窝淋巴结（ALN）的转移情况。     

Role of sentinel lymph node biopsy in patients with ductal carcinoma in situ and microinvasion

Aim: Ductal carcinoma in situ with microinvasion (DCISMI) is characterized by one or more areas of focal invasion, 1 mm or less in diameter. While pure ductal carcinoma in situ (DCIS) does not have the potential to metastasize to regional nodes, the presence of microinvasion makes lymph node metastasis possible, leading to current guidelines recommending staging of the axilla with sentinel lymph node biopsy (SLNB). However, there are few studies looking at the risk of lymphatic spread in patients with DCISMI, and indications for axillary staging in such cases is controversial. The aim of the present study was to assess the prevalence of nodal metastasis in patients with DCISMI in order to help ascertain whether SLNB can be safely avoided in DCISMI. Patients and Methods: A retrospective analysis was performed of patients undergoing surgery for DCIS over a 2‐year period (April 2006–08). Data were collected from the National Health Service Breast Screening Programme database and patient case notes. Patients having a SLNB had injection of radioisotope and blue dye. All SLNB were evaluated with serial sectioning and haematoxylin–eosin staining. Results: Over the 2‐year period, 399 screen‐detected breast cancers were treated, of which 310 (77 per cent) were invasive, 17 (4 per cent) had DCISMI and 72 (19 per cent) pure DCIS. The group with DCISMI was studied in more detail. Twelve out of the 17 patients had a wide local excision and five had a mastectomy. All 17 patients with DCISMI had a SLNB. No positive lymph nodes were found in this group. Conclusion: Our data suggest that the risk of nodal metastasis in DCISMI might be low, and question the role of SLNB in DCISMI. We highlight the lack of data on DCISMI and risk of nodal metastasis, and the need for further investigation.     

Women's choice between sentinel lymph node biopsy and axillary clearance

Purpose : To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. Methods : The expected 5‐year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. Results : One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC. Conclusions : Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC. Abbreviations: AC, axillary clearance; SLNB, sentinel lymph node biopsy.     

Clinical practice guidelines for the use of axillary sentinel lymph node biopsy in carcinoma of the breast: current update

Axillary sentinel lymph node biopsy (SLNB) has been adopted as a suitable alternative to traditional level I and II axillary dissection in the management of clinically node-negative (N0) breast cancers. There are two current techniques used to identify the sentinel node(s): radiopharmaceutical, technetium sulfur colloid, and isosulfan blue dye (used in the United States) and technetium-labeled albumin and patent blue dye (used in Europe). (The labeled albumin is not U.S. Food and Drug Administration [FDA] approved in the United States.) SLNB to replace axillary dissection should only be performed by surgeons and patient management teams with appropriate training and experience. Although both radiocolloid and blue dye are used together by most surgeons, and training should be in both techniques, some experienced surgeons use one or the other almost exclusively. In addition, surgical pathologists must recognize the need to examine these small specimens with great care, using a generally adopted protocol. Imprint cytology or frozen sections may be used, followed by additional sections for light microscopy. Immunochemical staining with cytokeratin or other techniques to identify "submicroscopic" metastasis is often used, but the results should not be used to influence clinical decisions with respect to adjuvant therapy. "Failed" SLNB implies the surgeon's failure to identify the sentinel nodes, in which case a complete dissection is performed. A "false-negative" SLNB implies the finding of metastasis in the excised sentinel nodes by light microscopy after a negative frozen section examination. Whether a false-negative SLNB mandates completion axillary dissection is controversial, with clinical trials currently under way to answer this question. Although SLNB was initiated to accompany breast-conserving treatment, it is equally useful in patients undergoing mastectomy. It is more difficult to perform with mastectomy. When using blue dye only, SLNB may require a separate incision because of time constraints between injection and identification of the blue-stained nodes; radiocolloid usually does not. Completion axillary dissection after false-negative SLNB is more difficult after mastectomy. SLNB is a useful procedure that may save 70% of women with clinically negative (N0) axillae and all of those with pathologically negative axillae from the morbidity of complete axillary dissection. Ideally the sentinel nodes should be able to identified in more than 95% of patients, with a false-negative rate of less than 5%. Until these rates can be achieved consistently, however, surgeons should not abandon traditional axillary dissection.