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。     

乳腺癌前哨淋巴结MRI研究进展

无创性方法准确评估乳腺癌前哨淋巴结状态对于避免不必要的外科手术及选择最佳治疗方案具有重要意义。扩散加权成像（DWI）和动态增强MRI(DCE-MRI)等多种MRI技术可为术前评估乳腺癌前哨淋巴结状态提供有价值的信息。就MRI评估乳腺癌前哨淋巴结状态的研究进展进行综述。     

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。     

乳腺癌前哨淋巴结活检技术的临床应用

目的:探讨前哨淋巴结活检(Sentinel lymph node biopsy,SLNB)在乳腺癌外科中的应用,并评价其准确性及可行性.方法:对2002-01～2004-01我院收治的161例Ⅰ、Ⅱ期乳腺癌病例,在常规行乳腺癌手术前均进行SLNB,即肿瘤局部皮内联合注射99mTc-DX及美蓝,根据核素示踪及美蓝染色结果寻找SLN并摘除,行冰冻病理检查.将SLNB结果与术后腋窝淋巴结病理结果进行分析.结果:161例中149例发现SLN,检出率为92.5%(149/161);共检出SLN273个,平均1.83个/例.比较SLNB与术后病理结果,SLNB检出灵敏度为96.1%(49/51),准确性98.7%(147/149),假阴性率3.9%(2/51),假阳性率0。结论:SLN可比较准确地反映腋窝淋巴结状况,SLNB是乳腺癌治疗中的实用技术.     

受体靶向荧光放射性药物用于多功能前哨淋巴结成像的研究

摘要目的探讨通过放射性核素和荧光对前哨淋巴结进行成像的多功能报告探针的成像及与受体结合的能力。材料与方法动物实验经动物保护和使用委员会批准。通过将花青素7(Cy7)和近红外花青染料共价连接到tilmanocept合成多功能报告探针,     

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。     

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。     

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.     

乳腺癌的前哨淋巴结定位

了解患者的腋窝淋巴结情况对判断早期乳腺癌的预后非常重要，它也对制定术后的治疗计划有所帮助。我们通过对前哨淋巴结的精确定位和病灶组织学评价准确地预测其它腋窝淋巴结的转移情况，从而避免了对阴性淋巴结病人进行腋窝根治手术。放射性示踪技术在前哨淋巴结的术前和术中定位中起着很重要的作用。理想的前哨淋巴结定位是在术前和术中进行放射性淋巴闪烁显像，同时淋巴闪烁显像也可以检查出病人腋公外的淋巴引流，从而可进行更适合的治疗。常规的前哨淋巴结定位，需要了解放射性药物或其他示踪剂的动力学及所使用的探测仪器。应用前哨淋巴结技术，外科医师、核医学医师和病理科医师之间需要紧密合作。     

Lymphatic mapping and retrieval of the sentinel lymph node in treatment of early breast cancer

Lymphatic mapping and sentinel lymph node biopsy is an important step to surgical individualization of breast cancer therapy. With lymphatic mapping and minimally invasive biopsy of one or two detected lymph nodes the method provides an exact evaluation of the nodal status. Using sentinel lymph node biopsy (SLNB), costs and morbidity of an axillary lymph node dissection (ALND) can be avoided in nodal negative patients, whereas nodal positive patients are chosen for ALND very selectively according to the detection of an increased percentage of micrometastases. While experienced centers are introducing this method into clinical practice for the benefit of patients with early-stage breast cancer in Europe, further research should focus on quality control, definition of standards considering the individual needs of the individual patient, and the evaluation of the impact of micrometastases. This article gives an overview of the current knowledge of SLNB and discusses critically current indications and methods as well as application techniques.     

Usefulness of sentinel lymph node detection in early stages of cervical cancer

Purpose Sentinel lymph node (SLN) mapping in combination with surgical biopsy is an emerging technique for use in the early stages of cervical cancer. The purpose of this study was to evaluate the technique in a series of 40 consecutive women with early stage cervical cancer.Methods Forty patients with early stage cervical cancer [FIGO stage IA2 (2), IB1 (34), IB2 (1) or IIA (3)] were referred for radical hysterectomy with pelvic lymphadenectomy. Patients were submitted to preoperative lymphoscintigraphy (four ^99mTc-nanocolloid injections around the tumour) and intraoperative SLN detection. Hand-held or laparoscopic gamma probes were used to locate SLNs during surgery.Results The mean number of SLNs was 2.5 per patient (interiliac 49%, external iliac 19%). Of the total of 99 SLNs, six, in four women, showed metastases (all 68 non-SLNs removed were negative). In the other 36 patients, all the removed lymph nodes (sentinel and non-sentinel) were negative (0% false negative rate). During the follow-up (median 25 months), only two patients presented distant metastases: one died 6 months after surgery (two of three SLNs positive, both hot and blue), while the second patient is alive 4 years after surgery (lung metastasis, no isotope drainage, negative blue SLN). The survival rate was 95% and disease-free survival, 97%.Conclusion SLN surgical biopsy based on lymphoscintigraphy and blue dye is a feasible and useful technique to avoid lymph node dissection in the early stages of cervical cancer. It has a high negative predictive value, can be incorporated into clinical routine (laparoscopy or open surgery) and is close to achieving validation in this setting.     

前哨淋巴结检测术在宫颈癌诊疗中的研究进展

宫颈癌在女性生殖器官肿瘤中发病率最高,淋巴结转移是其最主要的转移方式,前哨淋巴结是在原发肿瘤淋巴引流区域内,淋巴结发生转移必经的首站淋巴结,前哨淋巴检测术具有操作简单、检出率高、阴性预测值高等特点,其方法、病理学检查、影像因素对指导早期宫颈癌的根治性切除术,减少手术创伤、淋巴结微转移和制定合理的放疗计划等的研究具有重要意义.     

前哨淋巴结阳性乳腺癌腋窝淋巴清扫与保留上肢回流淋巴结清扫对照研究

目的对照研究2枚以下前哨淋巴结阳性的患者,施行常规腋淋巴结清扫和保留上肢回流腋淋巴结清扫应用新的腋下组分区法时,转移淋巴结的分布规律,及其对腋窝功能、术后恢复时间的影响。方法选取60例2枚以下阳性前哨淋巴结的患者,随机分成施行常规腋淋巴结清扫组(清扫组)和保留上肢回流腋淋巴结清扫组(保留组),每组各30例。术后将胸小肌外侧淋巴结按分区标准分成A、B、C、D四区,研究两组各区检出转移淋巴结的个数及分布规律,统计两组术后腋窝功能和出院时间,并进行分析。结果清扫组8例患者检出阳性淋巴结15枚,D区(上肢淋巴回流)未检出阳性淋巴结。保留组7例患者检出阳性淋巴结16枚,两组比较,差异无统计学意义(P>0.05)。两组术后腋窝功能恢复及住院天数比较,差异有统计学意义(P<0.05)。结论对于2枚以下前哨淋巴结阳性患者施行保留上肢回流腋淋巴结清扫,安全性等同常规腋淋巴结清扫,同时会较大程度保留腋窝功能和缩短术后恢复时间。     

Radioguided sentinel lymph node dissection in patients with localised prostate carcinoma: influence of the dose of radiolabelled colloid to avoid failure of the procedure

Introduction The purpose of this study was to determine the role of the injected dose of tracer in the non-detection of pelvic sentinel lymph nodes (SLN) in patients with prostate carcinoma. Methods Data were evaluated from 100 patients (age range 43–77, mean 63 years). The first 72 patients (group 1) received 2 × 0.3 ml of 30 MBq-nanocolloid-99 mTc and the remaining 28 patients (group 2) received 2 × 0.3 ml of 100 MBq. Surgery consisted of the detection and dissection of lymph nodes identified as sentinel nodes, followed by an extended lymphadenectomy. Results SLNs were located in the interiliac group in 54.2% of patients, in the obturator fossa in 30.7%, in the external iliac group in 10.9% and in the common iliac group in 4.2% of cases. Lymph node involvement was observed in 12% of patients. But there was a 30.6% (22/72) failure rate of the SLN procedure in group 1 and 7.1% (2/28) in group 2. An increased risk of unsuccessful SLN procedure was statistically associated with the low dose of MBq-nanocolloids (p < 0.017). Statistical correlation is also found after the exclusion of the first 30 patients from the study (learning phase of the team) (p < 0.034). None of the other parameters showed a statistical association (age, p < 0.9; Gleason score, p < 0.3; grade pT, p < 0.7). A higher grade or a greater extension of cancer inside the prostate are not responsible for the failure of the SLN procedure. Conclusion It seems necessary to inject at least 200 MBq inside the prostate to avoid a failed SLN procedure.     

核医学在乳腺癌前哨淋巴结活检术中的方法学研究现状

乳腺癌是女性最常见的恶性肿瘤之一,腋窝淋巴结清扫术一直被认为是乳腺癌外科治疗中最基本的手术方法。近年来发展起来的前哨淋巴结活检术因既能避免腋窝淋巴结清扫术引起的并发症,又能对乳腺癌进行准确地分期,具有操作简单、安全、准确率高、创伤小等优点,从而逐渐被国内外认可,已代替腋窝淋巴结清扫术成为治疗腋下淋巴结阴性患者的主要方法。在前哨淋巴结活检术中,核医学检查起了至关重要的作用,其中,放射性显像剂、注射技术、探测技术以及探测标准对乳腺癌腋下淋巴结和内乳淋巴结检测的准确率和假阴性率有着重要的影响,该文对近年来国内外关于核医学在乳腺癌前哨淋巴结活检术中的方法学研究现状进行综述。     

Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients

Purpose  Sentinel lymph node dissection (SLND) has replaced extended lymphadenectomy for nodal staging in several solid tumours. We present our results of SLND in prostate cancer in regard to detection and false-negative rate. Methods  In a 2-day protocol about 300 MBq ^99mTc-nanocolloid are injected into the prostate. Two hours later static scans of the pelvis are performed to get information about the number and location of radioactive lymph nodes. During surgery the radioactive nodes are excised with the help of a gamma probe and sent separately to the pathologist. The histological procedure includes haematoxylin and eosin staining, serial sections and immunohistochemistry. Results  Since 1999, a total of 2,020 men underwent SLND alone or in combination with either standard or extended lymphadenectomy after radical retropubic prostatectomy. Lymph nodes positive for metastases were found in 16.7% of patients. The scintigraphic detection rate was 97.6% and the intraoperative detection rate 98%. For 187 lymph node-positive men who had either standard or extended lymphadenectomy in addition to SLND the false-negative rate could be calculated, resulting in false-negative findings in 11 of 187 patients (6%). Conclusion  Our results demonstrate that SLND in prostate cancer is a reliable procedure for nodal staging.     

结肠癌前哨淋巴结微转移与FGFR4蛋白表达的关系

目的:探讨结肠癌淋巴结转移与成纤维细胞生长因子受体-4(FGFR4)蛋白的关系。方法:68例结肠癌患者,男43例,女25例,年龄34~86岁。术中染料法定位前哨淋巴结(SLN),抗CEA免疫组化法检测SLN微转移,W estern B lot法测定组织内FGFR4蛋白表达。结果:每例患者的SLN数量1~4枚,平均为2.4枚(158/65)。SLN转移率为69.2%(45/65)。癌组织内FGFR4蛋白表达率为47.1%(32/68),有SLN转移者癌组织内FGFR4蛋白表达率为55.3%(26/47),无SLN转移者达率为28.6%(6/21),有显著性差别(P<0.05)。结论:部分结肠癌组织内有FGFR4蛋白表达是结肠癌易发生淋巴结微转移原因之一。