腹腔镜下前哨淋巴结活检术在早期宫颈癌治疗中的临床价值

目的探讨腹腔镜下前哨淋巴结活检（SLNB）术在早期宫颈癌治疗中的临床价值。方法选择诊断明确的早期宫颈癌患者54例设为研究组,采用亚甲蓝淋巴显影后行腹腔镜下SLNB及盆腔淋巴结清扫和广泛子宫切除术;另将48例仅行腹腔镜下盆腔淋巴结清扫加广泛性子宫切除术的早期宫颈癌患者设为对照组。观察研究组SLNB对预测盆腔淋巴结有无肿瘤转移的准确性、假阴性率及SLN分布情况等;对两组患者的手术时间、术中出血量、切除的盆腔淋巴结（PLN）数及医院感染发生率等数据进行对照分析;并对研究组患者的医院感染相关因素进行分析。结果研究组SLN检出率为79．63％（43／54）,SLNB预测盆腔淋巴结转移的准确性95．35％（41／43）、灵敏度75％（6／8）、特异度100％（35／35）、阴性预测值94．59％（35／37）、阳性预测值100％（6／6）;研究组与对照组比较,手术时间明显增加,术中出血量明显减少,切除的PLN数明显增多,其差异均有统计学意义（P〈0．01）,医院感染发生率比较差异无统计学意义（P〉0．05）;研究组患者医院感染各相关因素组内比较差异均无统计学意义（P〉0．05）。结论腹腔镜下SLNB能较准确地预测盆腔淋巴结的状况,在早期宫颈癌治疗中具有较高的临床价值。     

术前活检与术中快速冷冻病理检查诊断早期乳腺癌前哨淋巴结转移的价值研究

目的 分析术前活检和术中快速冷冻病理检查在乳腺癌前哨淋巴结假阴性诊断中的差异.方法 选取2014年12月—2018年7月哈励逊国际和平医院住院的有乳腺癌前哨淋巴结转移并行腋窝淋巴结清扫术患者150例,分为术前活检组和术中冷冻组.依据术前穿刺、术中冷冻和术后石蜡切片病理结果,对术前活检组患者术前、术后病理一致性(术前活检...     

子宫颈癌手术中前哨淋巴结问题的研究进展

子宫颈癌是目前妇科治疗预后较好的肿瘤，总的生存率可达65％。治疗措施应根据临床分期、患者年龄、全身情况、设备条件和医疗技术水平决定。常用方法有手术、放疗及化疗等综合应用，目前手术仍然是治疗宫颈癌的主要的有效措施。对于Ⅰb～Ⅱa期患者，标准手术方式采用子宫根治术及盆腔淋巴结清扫术，子宫颈癌手术治疗已有一百多年的历史，子宫颈癌的根治手术，已趋成熟。近年来，为了提高子宫颈癌患者的生存率和降低术后并发症，改善患者的生存质量，现结合文献对宫颈癌的治疗方面综述如下：     

乳腺癌前哨淋巴结术中分子诊断的研究

目的 评估乳腺癌前哨淋巴结(SLN)术中分子诊断--GeneSearchTM BLN Assay (BLNa)的诊断价值.方法 2009年2至6月,全国6家乳腺中心的479例乳腺癌患者入组本研究.SLN均垂直于长轴切割为1.5～3 mm组织块,术中奇数组织块行BLNa检测,术后偶数组织块行逐层切片病理检测(采用间隔150 μm的逐层切片HE染色,每个组织块取6张切片).214例患者的偶数组织块行术中快速冰冻病理(FS)检测,156例患者的所有组织块术中行印片细胞学(TIC)检测.结果 BLNa操作呈现良好的学习曲线,各中心的敏感性和特异性差异均无统计学意义(分别P=0.672;P=0.628),中位操作时间约35 min.以病例数为统计对象分析,BLNa的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为91.4%、87.5%、92.9%、81.8%、95.3%,其敏感性与FS相似(84.5%,P=0.576),显著优于TIC(75.0%,P=0.049).以淋巴结数为统计对象分析,BLNa的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为93.0%、85.6%、94.6%、76.6%、96.9%,其敏感性与FS相似(84.9%,P=0.885),显著优于TIC(70.0%,P=0.007).对于伴有宏转移的SLN,BLNa的敏感性为93.6%,与FS相似(95.6%,P=0.558),显著优于TIC(80.9%,P=0.011);对于伴有微转移的SLN,BLNa的敏感性为57.5%,有优于FS和TIC的趋势(分别44.4%,P=0.356;30.8%,P=0.094).结论 GeneSearchTM BLN Assay检测快速,易于操作,具有较高的准确性和可重复性,其敏感性优于FS和TIC,可作为SLN术中诊断的首选.

Abstract：

Objective To evaluate the clinical value of GeneSearchTM BLN Assay as an intraoperative diagnostic method of sentinel lymph node (SLN) for breast cancer patients. Methods A total of 479 consecutive patients from six centers were involved in this prospective study. The SLNs were identified,dissected and then sectioned along the short axis into multiple blocks. The odd blocks were tested intraoperatively by the above-mentioned assay and the even blocks assessed post-operatively by histopathologic examination. The 4 -6 μm thick stepwise sectioning permanent HE slides were prepared every 150 μm and one block yielded 6 slides. In addition, the even blocks of 136 patients were prepared for frozen section (F S) and all blocks of 156 patients evaluated intra-operatively by touch imprint cytology (TIC). Results In the node basis analysis, its accuracy, sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) were 93.0%, 85.6%, 94. 6%, 76.6% and 96.9% respectively. Its sensitivity was similar to that of FS ( 84. 9%, P = 0. 885 ) and significantly higher than that of TIC (70. 0%, P = 0. 007 ).When assessing nodes with macro-metastases, its sensitivity was similar to that of FS (93.6% vs 95.6%,P =0. 558) and significantly higher than that of TIC (93.6% vs 80.9%, P = 0. 011 ). When assessing nodes with micro-metastases, it had a higher sensitivity than that of FS (57.5% vs 44.4%, P =0. 356) and TIC (57. 5% vs 30. 8%, P =0. 094). In the patient basis analysis, the accuracy, sensitivity, specificity,PPV and NPV were 91.4%, 87. 5%, 92. 9%, 81.8% and 95. 3% respectively. Its sensitivity was similar to that of FS (84. 5%, P =0. 576) and significantly higher than that of TIC (75.0%, P =0. 049). After adjustment, it had the accuracy, sensitivity, specificity, PPV and NPV of 91.7%, 83. 5%, 95.2%,88. 3% and 93.0% respectively. Its sensitivity was higher than that of FS (72. 1%, P = 0.054) and significantly higher than that of TIC ( 66. 7%, P= 0. 011 ). The two had no significant difference in the sensitivity and specificity. After a learning curve of around 10 cases, it could be performed in a median time of around 35 min. The threshold cycle time values of MG and CK-19 were 36 and 31 respectively. The type of metastases could be estimated approximately according to the cycle time values. The cycle time values of MG under 33 indicated SLN macro-metastases and those of 33 - 36 denoted micro-metastases. The values of CK-19 under 29 indicated SLN macro-metastases and those of 29 -31 denoted micro-metastases. Conclusion As an accurate and rapid intra-operative assay for breast sentinel lymph nodes, the GeneSearchTM BLN Assay may replace FS and TIC in general medical practice.     

早期乳癌前哨淋巴结活检

目的：探讨前哨淋巴结活检技术在早期乳癌临床应用可行性及预测早期乳癌腋窝淋巴结状况的准确性。方法：60例早期乳癌病人,在术前15min分别于瘤体或活检后残腔的内、外、上、下4点分别注射亚甲蓝4mL,然后行乳癌改良根治术、乳腺区段切除术加腋窝淋巴结清扫术。切除标本沿溜外上方寻找最近的蓝染淋巴结即前哨淋巴结。结果：52找到前哨淋巴结,成功率为86.67%,前哨淋巴结预测腋窝淋巴结状况的准确率为94.23%。结论：亚甲蓝染色法可用于检出早期乳癌前哨淋巴结,其组织学性状能较准确预示早期乳癌腋窝淋巴结的状况。     

早期宫颈癌前哨淋巴结的定位和活检

目的:研究宫颈癌前哨淋巴结的定位活检方法,探讨前哨淋巴结对盆腔淋巴结状态的预测价值及其临床意义.方法:选择早期宫颈癌患者31例,术前宫颈癌周注射亚甲蓝,次日行广泛子宫切除 盆腔淋巴结清扫术;蓝染的淋巴结即为前哨淋巴结,分析前哨淋巴结(SLN)在盆腔的检出情况及影响因素.结果:SLN识别率为84%(26/31),SLN对盆腔淋巴结状况预测的灵敏性为86%,准确性为96%;假阴性率为14%.影响SLN识别率的相关因素为肿瘤直径及术前治疗.结论:使用亚甲蓝识别早期宫颈癌前哨淋巴结技术是可行的,但其临床应用价值还需要多中心、大样本病例的前瞻性随机对照研究证实.     

前哨淋巴结活检在早期乳腺癌中的临床价值

目的探讨前哨淋巴结活检预测早期乳腺癌腋淋巴结肿瘤转移的准确性及其I临床意义。方法本组96例早期乳腺癌患者,术前10min用专利蓝液4ml注射到肿瘤周围,然后行乳腺癌改良根治术。在切除标本中,从原发肿瘤周围先解剖出染色淋巴管,然后追寻到第一站引流淋巴结(前哨淋巴结),进行病理检查。结果在96例乳腺癌患者中成功活检出前哨淋巴结79例,成功率82．3％。54％(43／79)的患者前哨淋巴结与腋淋巴结性质相符(8例均阳性,35例均阴性),46％(36／79)的患者仅为前哨淋巴结阳性,无1例发生淋巴结跳跃性转移。前哨淋巴结转移同肿瘤的位置、病理类型无关,但同肿瘤的大小有关。结论早期乳腺癌在淋巴管播散中呈序贯性,前哨淋巴结活检能准确地预测大多数乳腺癌患者腋淋巴结的转移情况。     

宫颈癌前哨淋巴结微转移检测意义

0 引言 转移是恶性肿瘤的一个重要标志,是肿瘤手术后复发和放疗及化疗失败的主要原因.微转移的检测对肿瘤的诊断、分期、复发和预后的判断、手术、综合治疗的选择具有极其明显的指导作用.我们采用抗角蛋白免疫组化染色方法对宫颈癌患者进行淋巴结微转移的检测,探讨免疫组化对宫颈癌淋巴结微小转移诊断的准确性.     

宫颈癌淋巴结的评估与手术策略探讨

宫颈癌是妇科常见的恶性肿瘤之一。手术治疗是早期宫颈癌的重要治疗方式。宫颈癌患者是否存在淋巴结转移对评估宫颈癌预后及治疗方案的选择具有重要的意义,而术前根据淋巴结转移的相关危险因素及影像学检查结果评估淋巴结转移的情况,有助于临床制订手术策略。近年来,前哨淋巴结活检术因其安全性及可行性已被推荐应用于早期宫颈癌患者的手术治疗,可根据宫颈癌患者术前淋巴结评估情况选择性地进行前哨淋巴结活检、系统性淋巴结切除及腹主动脉旁淋巴结切除,根据术中淋巴结转移情况可制订相应的手术切除范围。因此,宫颈癌淋巴结的评估尤其是手术策略的制订在宫颈癌治疗中具有重要的意义。     

Sentinel lymph node identification in patients with early stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy

Background In general, sentinel lymph node (SLN) can reflect the whole state of the entire drainage area. The present study evaluated the clinical significance of sentinel lymph node identification in the treatment of early stage cervical cancer.Methods Twenty-eight patients with early stage (la -Ila) cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in this study. At two locations 8 hours before operation, 0.4 ml 37 Mbq technicium-99 labeled dextran was injected intracervically. After that,preoperative lymphoscintigraphy was performed to detect SLNs. During the operation, lymph nodeswere detected ex vivo by a γ-counter to identify SLNs. The samples of SLNs and non-SLNs were used for Datholoaical examination separately and compared with the final results.results SLNs were identified in 27 of 28 (96.4%) patients. A total of 123 SLNs were identified from 814 nodes. Six patients had altogether 11 positive lymph nodes, which were all SLNs. No patient had false-negative sentinel node.Conclusion SLNs can successfully predict the lymphatic metastasis in patients with cervical cancer.The clinical validity of this technique should be evaluated prospectively.     

早期宫颈鳞癌盆腔淋巴结微转移的探讨

目的:探讨免疫组化法检测早期宫颈鳞癌患者淋巴结内微转移及其临床意义。方法:回顾性分析14例FIGO分期(1995)为ⅠA～ⅡA期宫颈鳞癌患者的临床资料,对术后的228枚盆腔淋巴结的石蜡包埋组织以抗细胞角蛋白抗体AE1/AE3标记。结果:14例228枚淋巴结中,3例患者3枚淋巴结发现微转移病灶,病例总阳性率21.4%,淋巴结总阳性率1.3%。髂外淋巴结组、闭孔淋巴结组的检出率为3.8%(2/53)和1.1%(1/87)。随着临床分期的增加,微转移的检出率逐渐增大(χ2=8.601,P<0.05)。结论:早期宫颈鳞癌患者盆腔淋巴结中存在微转移病灶,可通过免疫组化法检出,对指导治疗、判断预后有积极临床意义。     

Sentinel lymph node detection by combined dye-isotope technique and its predictive value for cervical lymph node metastasis in patients with lingual carcinoma

Objectives To investigate the clinical value of combined dye-isotope technique in detecting sentinel lymph node (SLN) and to examine whether the characteristics of SLN accurately predict cervical lymph node metastasis in lingual carcinoma.Methods Thirty patients with lingual carcinoma without lymph metastasis were injected with a dose of about 18. 5 MBq of ^99mTc-SC (sulfur colloid), around the tumor tissues before surgery, and lymphoscintigraphy was performed 5, 10, 30, 60 minutes, and 6 hours after injection. In the following day, all patients were injected with isosulfan blue dye around the primary tumor during surgery to trace SLN and underwent standard cervical lymph node dissection after SLN dissection. The pathological results of SLN were compared with standard lymph node dissection for their ability to accurately predict the final pathological status of the cervical lymph nodes.Results SLN was successfully identified in 100% of the patients. Both positive and negative predictive values of SLN were 100%. The accuracy rate was 100%, and there were no false negatives.Conclusions The detection of SLN using combined dye-isotope technique could accurately predict cervical lymph node metastasis in lingual carcinoma.     

用核素法探测宫颈癌前哨淋巴结的临床意义

目的 探讨前哨淋巴结(SLN)检测在子宫颈癌根治术中的临床价值.方法 用放射性核素定位法探测宫颈癌前哨淋巴结,选择2005年12月-2006年12月在新疆医科大学第一附属医院住院的妇女早期宫颈癌患者16例.术前均取子宫颈组织活检,病理证实为CINⅢ级累及腺体及子宫颈癌Ⅱb期以前的患者,所有病例根据术前盆腔检查情况按FIGO2000年标准进行临床分期.术前于宫颈12°、4°、8°在距肿瘤边缘5～10 mm的黏膜下分别注射锝-99m硫化胶体,行即刻平面显像及断层显像(定位)或视情况行延迟显像.术中行γ探针探测前哨淋巴结,摘除有强放射性的淋巴结,进行病理学检查,行广泛子宫切除加盆腔淋巴结清扫术.结果 16例患者共切除淋巴结138枚,平均每例9枚.8枚有SLN,其中7枚淋巴结病理阳性.130枚无SLN,病理结果均为阴性.SLN活检术灵敏度为100%,特异度99.2%.SLN分布情况与术前核素淋巴显像结果相符.结论 SLN检测能准确地预测早期宫颈癌盆腔淋巴结的转移状况,但SLN活检术的可行性还需要更大样本量的研究来进一步评价.     

Sentinel lymph node biopsy in breast cancer

Objectives:

To report our experience in sentinel lymph node biopsy (SLNB) in early breast cancer.

Methods:

This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node (SN), SLNB results, axillary recurrence rate and SLNB morbidity.

Results:

There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors (97.6% success rate). No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection (ALND), whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN’s by hematoxylin & eosin (H&E) and immunohistochemical staining for doubtful H&E cases, 10 turned out to have micrometastases (6 had delayed ALND and 4 had no further axillary surgery). Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal.

Conclusion:

The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity.Breast cancer (BC) is the top cancer in women both in the developed and developing world.1 In the USA, nearly 230,000 BCs are diagnosed annually.2 The population of Kingdom of Saudi Arabia (KSA) is approximately 30 million, 65% of them are below the age of 30.3 In KSA, the total number of patients diagnosed to have BC in the year 2010 was 1,473 patients, which constituted 27.4% of all newly diagnosed female cancers in the year 2010. The Age Standardized Rate was 24.9/100,000 for female population. The median age at diagnosis was 49 years. More than half of BC patients in KSA presented with locoregional or distant disease.4 In KSA, there is no national screening program for BC and the Saudi Cancer Registry does not include ductal carcinoma in situ (DCIS) cases in their capture form, which may explain the low number of DCIS cases reported from local centers. It is clear that, KSA is among countries with low disease burden, but it is expected that this burden will increase in the years to come.5 Axillary lymph node status is considered the most important prognostic factor for patients with BC, and it participates largely in the decision regarding subsequent adjuvant systemic treatment.6,7 Axillary lymph node dissection (ALND) for patients with BC was introduced more than 200 years ago for staging and local control.8,9 It is associated with an increase risk of adverse outcomes, including lymphedema in 14% of cases, limited shoulder motion in 28% of the cases and neuropathic pain in 31% of the cases.10 The therapeutic advantage of removing negative nodes with respect to axillary control and survival remains questionable.11-14 At the present time, most BC patients receive some sort of adjuvant systemic therapy irrespective of their lymph node status.15 Based on that, minimally invasive procedures for staging the axilla have been introduced. Sentinel lymph node biopsy (SLNB) in BC, a minimally invasive procedure, was first described in 1994.16 Since then, it has been widely practiced with a wide literature to support its reliability for ascertaining the status of the axillary lymph nodes. Currently, SLNB is accepted as the standard of care for axillary staging in early BC.17-19 In this paper, we are documenting the beginning, development, results and follow up of patients who underwent SLNB for BC at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.     

乳腺癌前哨淋巴结的临床病理意义

目的:探讨乳腺癌淋巴结勘测性前哨淋巴结活检对于临床病理的意义.方法:对54例 T1及T2浸润性乳腺癌患者实行勘测性前哨淋巴结切除术(sentinel lymph node dissec tio n, SLND)和腋窝淋巴结切除术(axillary lymph node dissection, ALND).T1肿瘤直径< 2 cm,T2肿瘤直径2～5 cm.乳腺癌前哨淋巴结(sentinel lymph node,SLN)的勘测用活性蓝示踪法识别.SLN经常规苏木精和伊红(hematoxylin and eosin,HE)染色、病理分析及连续多层切片检查.结果:54例T1及T2浸润性乳腺癌100%发现前哨淋巴结,共切除168个,1 5例29个前哨淋巴结见癌转移,SLN及腋窝淋巴结(axillary lymph node,ALN)均未转移38 例,SLN癌转移、ALN未见转移5例,SLN及ALN均见转移10例,SLN假阴性1例.常规病理检查阴性的SLN经过连续多层面切片1例发现微小转移灶.结论:SLND对于发现乳腺癌腋下转移有高的敏感性,是一个有用的、准确评价腋窝淋巴结转移的方法.     

前哨淋巴结活检联合乳房区段切除术治疗早期乳腺癌患者的围手术期护理观察

目的 探讨前哨淋巴结活检联合乳房区段切除手术即保乳保腋术相比传统乳腺癌改良根治术对早期乳腺癌患者的手术创伤的区别及优势。 方法 选取蚌埠医学院第一附属医院2012年8月-2013年8月收治的120例乳腺癌患者,按随机数字表法分为对照组和观察组,每组各60例。对照组患者为接受传统乳腺癌改良根治术治疗的患者,观察组患者为接受前哨淋巴结活检并在术中冰冻提示阴性而免除腋窝淋巴结活检的前提下联合乳房区段切除术(保乳保腋术)治疗的患者。术后2组患者根据术后病理、淋巴结转移情况(仅观察组)及免疫组化的结果均接受对应的化疗、内分泌治疗或放疗等辅助治疗,其中观察组患者术后必行辅助放疗。分别比较2组患者的手术时间,术中出血量、术后并发症的发生情况以及术后的康复时间,同时比较2组患者术后的3年存活率、复发率及转移率。 结果 观察组患者的手术时间、术中出血量、术后住院时间、术后并发症的发生率、术后康复时间均低于对照组,差异有统计学意义(均P<0.01),同时2组患者术后3年存活率、复发率及转移率比较差异无统计学意义(均P>0.05)。 结论 前哨淋巴结活检联合乳房区段切除术相比传统改良根治术而言可有效减少患者的手术时间、术中出血量,同时减少术后不良反应发生,提高生活质量,未降低患者术后存活率,且没有增加复发、转移率。      

前哨淋巴结活检在甲状腺乳头状癌的临床应用

目的探讨前哨淋巴结（sentinel lymphnode,SLN）活检术在甲状腺乳头状癌中应用的准确性及可行性。方法19例45岁以上临床淋巴结阴性（cN0）的甲状腺乳头状癌患者,术中在肿瘤周围4点注射2％美蓝,获取染色淋巴结,再行肿瘤侧甲状腺腺叶、峡部切除、对侧次全切除及改良式颈部淋巴结清扫。所有淋巴结分区送常规病理检查。结果19例中,18例显示了SLN,平均每例2．5枚,13例SLN阳性,1例非SLN阳性,1例未检出SLN发现有淋巴结转移。SLN活检的灵敏度为86．6％,准确度为94．4％,阴性预测值为80％,阳性预测值为100％。结论SLN活检能准确预测颈部淋巴结状态,对cN0甲状腺乳头状癌的手术治疗方案有重要指导意义。     

新辅助化疗对可手术乳腺癌前哨淋巴结病理结果的影响

目的：研究新辅助化疗后乳腺癌前哨淋巴结活检结果是否真实可靠.方法：60例乳腺癌患者手术前应用2～3个疗程的新辅助化疗;48例化疗方案采用CEF（环磷酰氨60mg/m2,表柔比星70mg/m2,氟脲嘧啶60mg/m2）,12例患者采用CET（环磷酰氨50mg/m2,表柔比星50mg/m2,多西紫杉醇75mg/m2）.乳腺癌改良根治术前取亚甲蓝2ml皮下均衡注射于肿瘤四周各个象限,切除的标本计数淋巴结总数和染蓝的淋巴结数,与大体标本同时作常规病理检查.结果：66例乳腺癌患者中,60例前哨淋巴结染色成功（90.9%）,平均检查前哨淋巴结数为1～5枚/例.8例在手术前肿瘤已局部切除的患者前哨淋巴结均染色成功.60例患者前哨淋巴结癌转移阳性23例,其中同时腋窝淋巴结阳性15例,阴性8例.前哨淋巴结阴性的37例患者中,腋窝淋巴结阴性35例、阳性2例（前哨淋巴结假阴性占5.4%）,假阴性率为8%.48例采用CEF方案的患者,前哨淋巴结假阴性1例.12例采用CET方案的患者,前哨淋巴结假阴性1例.60例患者中58例前哨淋巴结准确地预测了腋窝淋巴结转移状况.结论：采用CET或CEF方案新辅助化疗的乳腺癌患者,其前哨淋巴结检查的病理结果同样能准确地反映腋窝淋巴结的转移状况.