32P胶体局部给药防治H22移植瘤淋巴道转移的实验研究

目的探讨不同剂量的^32P胶体局部注射对小鼠H22移植瘤和区域淋巴结转移灶的治疗作用。方法应用小鼠H22腹水型肝癌淋巴道转移模型，通过肿瘤组织局部给药，观察^32P胶体在模型小鼠移植瘤、区域淋巴结及全身各器官、组织内的分布。结果^32P胶体局部给药后主要聚集在瘤体注射局部和区域淋巴结内，而在肝、脾、肺等脏器分布的活度较低。区域淋巴结聚集的活度随给药剂量增高而递增。治疗早期瘤体和胭窝淋巴结转移灶呈现局灶性坏死。后期移植瘤和区域淋巴结转移灶的瘤组织呈现出血、坏死。结论^32P胶体瘤体给药可在局部富集，并可经淋巴道转运、聚集于区域淋巴结，对肿瘤组织和邻近的淋巴结转移灶具有明显的杀伤作用。     

Radioguided sentinel lymph node biopsy in malignant cutaneous melanoma.

The procedure of sentinel lymph node biopsy in patients with malignant cutaneous melanoma has evolved from the notion that the tumor drains in a logical way through the lymphatic system, from the first to subsequent levels. As a consequence, the first lymph node encountered (the sentinel node) will most likely be the first affected by metastasis; therefore, a negative sentinel node makes it highly unlikely that other nodes in the same lymphatic basin are affected. Although the long-term therapeutic benefit of the sentinel lymph node biopsy per se has not yet been ascertained, this procedure distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of lymphedema, from those with metastatic involvement, who may benefit from additional therapy. Sentinel lymph node biopsy would represent a significant advantage as a minimally invasive procedure, considering that an average of only 20% of melanoma patients with a Breslow thickness between 1.5 and 4 mm harbor metastasis in their sentinel node and are therefore candidates for elective lymph node dissection. Furthermore, histologic sampling errors (amounting to approximately 12% of lymph nodes in the conventional routine) can be reduced if one assesses a single (sentinel) node extensively rather than assessing the standard few histologic sections in a high number of lymph nodes per patient. The cells from which cutaneous melanomas originate are located between the dermis and the epidermis, a zone that drains to the inner lymphatic network in the reticular dermis and, in turn, to larger collecting lymphatics in the subcutis. Therefore, the optimal route for interstitial administration of radiocolloids for lymphoscintigraphy and subsequent radioguided sentinel lymph node biopsy is intradermal or subdermal injection. (99m)Tc-Labeled colloids in various size ranges are equally adequate for radioguided sentinel lymph node biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas along the midline of the head, neck, and trunk, particular consideration should be given to ambiguous lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy because images are used to direct the surgeon to the sites of the nodes. The sentinel lymph node should have a significantly higher count than that of the background (at least 10:1 intraoperatively). After removal of the sentinel node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. Virtually the entire sentinel lymph node should be processed for histopathology, including both conventional hematoxylin-eosin staining and immune staining with antibodies to the S-100 and HMB-45 antigens. The success rate of radioguidance in localizing the sentinel lymph node in melanoma patients is approximately 98% in institutions that perform a high number of procedures and approaches 99% when combined with the vital blue-dye technique. Growing evidence of the high correlation between a sentinel lymph node biopsy negative for cancer and a negative status for the lymphatic basin-evidence, therefore, of the high prognostic value of sentinel node biopsy-has led to the procedure's being included in the most recent version of the TNM staging system and starting to become the standard of care for patients with cutaneous melanoma.     

MR contrast agents in lymph node imaging

The detection of tumor metastases in lymph nodes is clinically important for tumor staging and therapy planning in cancer patients. However, differentiating between malignant and benign lymph nodes is still a problem because current imaging modalities rely only on the size and shape of the lymph nodes. Thus, small metastases in normal-sized lymph nodes can be missed, and it is difficult to differentiate enlarged nodes (benign hyperplasia versus malignant disease). Therefore, a specific lymphotropic contrast agent is needed to obtain a high contrast between functional and metastatic tissue. Contrast-enhanced MR lymphography is a noninvasive method for the analysis of the lymphatic system after interstitial (intracutaneous or subcutaneous) or intravenous application of contrast media. Interstitial MR lymphography using extracellular, liposomal, polymeric, lipophilic or particulate contrast agents results in high accumulation in regional lymph nodes. The systemic administration of a lymphotropic contrast medium is needed to address each individual lymph node. Ultrasmall superparamagnetic iron oxide particles are in late-stage clinical development for this indication, but they take 24h to show sufficient contrast. Recently, a gadolinium-type contrast agent (Gadofluorine M) was described that detected lymph node metastases within 60 min of intravenous injection.     

Lymphatic metastasis from tumors transplanted into the pre-irradiated footpad of the rat

Background

In the literature there is some evidence that the incidence of metastases may increase after radiation treatment.

Methods

In order to investigate whether radiation-induced changes in the lymphatic drainage may alter the rate of lymph node metastasis, the center part of the left hind foot of rats was irradiated with a dose of 1 x 55 Gy before inoculation of tumor cells into the irradiated part of the footpad at different time intervals. Cells of 2 different tumor lines were employed. A rarely metastasising rhabdomyosarcoma, R-l, to look for a possible enhancement of lymphatic metastases, and a readily metastasising mammary carcinoma, Cl-2, in case of a possible decrease in the rate of lymphatic metastasis from tumors growing in pre-irradiated footpads.

Results

The incidence of regional lymph node metastasis decreased for R-l tumors growing in pre-irradiated footpads, but not for Cl-2 tumors. Furthermore, the average time required for lymph node metastasis to attain a reference volume of 100 mm³ is not significantly influenced by pre-irradiation of the footpad. No difference was observed in average times for doubling in volume of lymph node metastases originating from primary tumors in pre-irradiated footpads. Abscopal effects after footpad irradiation may cause a 50-fold increase in size of regional lymph nodes and, therefore, histological examination is essential for verification of lymph node metastases.

Conclusions

Damage to the lymphatic system to be expected in the irradiated footpad did not enhance the incidence of regional metastasis of R-1 tumors. A reduced rate of lymphatic metastasis contradicts earlier findings of enhanced lymphatic metastasis development of R-l tumors, growing in pre-irradiated gastrocnemius muscles. The influence of irradiation on regional metastasis formation seems to be “tumor bed” dependent for R-l tumors.     

Interstitial MR lymphography with MS-325: characterization of normal and tumor-invaded lymph nodes in a rabbit model

OBJECTIVE: The aim of our study was to evaluate the performance of a new blood-pool contrast agent, MS-325, in depicting regional lymph nodes when injected interstitially and in allowing the subsequent classification of the lymph nodes as normal or tumor-bearing (VX2 tumor). MATERIALS AND METHODS: Six New Zealand white rabbits underwent adapted fast three-dimensional (3D) MR imaging before implantation of VX2 tumor cells in the flank and again 3 weeks after the implantation. For each imaging session, 0.5 mL of undiluted MS-325 was injected subcutaneously into both dorsal foot pads. For more than 120 min, the rabbits underwent repeated 3D MR imaging. The size of the individual lymph nodes and the amount of contrast agent uptake in the nodes were measured 5, 10, 15, 30, 60, and 120 min after the injection. After the rabbits had been sacrificed, their lymph nodes were removed and histopathologically analyzed. RESULTS. In normal as well as tumor-bearing hindlegs, the subcutaneous administration of MS-325 resulted in rapid delineation of popliteal, inguinal, iliac, and paraaortal lymph nodes. Tumor invasion into lymph nodes presented as circumscribed signal voids in the areas infiltrated by tumor, whereas the surrounding residual lymphatic tissue showed enhancement identical to that of normal nodes. CONCLUSION: In addition to providing a safe means of displaying the normal lymphatic system, MS-325-enhanced 3D MR lymphography depicts direct tumor invasion in lymph nodes.     

早期胃癌淋巴结转移多因素分析

目的探讨早期胃癌淋巴结转移规律,为微创治疗、缩小手术范围提供依据。方法对解放军总医院1983-2005年间诊治的308例早期胃癌患者进行回顾性分析,其中282例术后找到淋巴结,对其年龄,性别,肿瘤大小、部位、大体类型、分化程度、浸润深度,淋巴管癌栓,癌旁黏膜萎缩、肠化、异型增生等与淋巴结转移的关系进行单因素及多因素分析。结果早期胃癌淋巴结转移率为9．9％（28／282）,黏膜（M）癌淋巴结转移率为2．5％（4／157）,黏膜下层（SM）癌淋巴结转移率为19．2％（24／125）。Logistic回归分析提示,淋巴管癌栓（P=0．000,OR=8．568）、浸润黏膜下层（P=0．018,OR=4．234）、肿瘤〉2cm（P=0．020,OR=4．12）、分化不良（P=0．040,OR-2．710）为淋巴结转移的独立危险因子。进一步分层分析提示,影响M癌淋巴结转移的因素为肿瘤大小、淋巴管癌栓,≤2cm的M癌不论分化程度如何均无淋巴管癌栓,也无淋巴结转移（0／108）,2-4cm、无淋巴管癌栓的M癌不论分化程度如何均无淋巴结转移（0／26）;影响SM癌淋巴结的因素为肿瘤大小、组织学类型、淋巴管癌栓,≤2cm、分化良好型、无淋巴管癌栓的SM癌均无淋巴结转移（0／25）,2era、分化不良型、有淋巴管癌栓的SM癌淋巴结转移率72．7％（8／11）。结论肿瘤大小、淋巴管癌栓与M癌淋巴结转移相关,肿瘤大小、组织学类型、淋巴管癌栓与SM癌淋巴结转移相关。     

Evaluation of the sentinel lymph node combining SPECT/CT with the planar image and its importance for the surgical act

The sentinel node biopsy procedure is based on the hypothesis of the existence of an orderly and predictable pattern of lymphatic drainage to a regional lymph node basin. This results in the consideration of all lymph nodes with direct drainage from the primary tumor as sentinel nodes. The sentinel node is not necessarily the hottest or the most nearby node, although this is often the case. Lymphoscintigraphy has been an essential component for preoperative sentinel node identification. With the new generation of multimodality gamma cameras, SPECT/CT has been incorporated into the sentinel node procedure. The resulting SPECT/CT fused images depict sentinel nodes in an anatomical landscape providing a helpful roadmap for surgeons. Therefore, it is necessary to define the role of SPECT/CT in relation to the classical planar lymphoscintigraphy for the identification of sentinel nodes. To understand the combined use of lymphoscintigraphy and SPECT/CT, the criteria for sentinel node identification on preoperative images must be specified. The authors, based on their experience in this field, present tentative criteria to identify lymph nodes as sentinel nodes both in planar and SPECT/CT images and classify them into different categories. The use of these scintigraphic categories to characterize radioactive lymph nodes is also helpful for surgical decision making.     

Lymphoscintigraphy in cutaneous melanoma: a total body atlas of sentinel node mapping.

Lymphoscintigraphy of malignant melanoma has been a reliable method of identifying regional lymph nodes at risk for metastases and is now considered part of the standard of care in patients with melanoma. The status of the sentinel lymph node (SLN) is predictive of the metastatic status of the corresponding regional lymph node group. Lymphatic channel mapping allows identification of the SLN, thereby making selective lymph node sampling possible. Consequently, SLN identification with lymphoscintigraphy results in both less extensive surgery and more efficient pathologic examination of the lymph node specimens. Therefore, it is imperative that radiologists and nuclear medicine physicians know which radiopharmaceuticals to use, recognize different lymphatic drainage patterns from various primary tumor sites throughout the body, use proper imaging techniques, and recognize potential pitfalls in image interpretation.     

In-111 DTPA octreotide scintigraphy and intraoperative gamma probe detection in the diagnosis and treatment of residual lymph node metastases of a rectal carcinoid tumor

PURPOSE: We report a case of a rectal carcinoid tumor that was treated using endoscopic resection. This case highlights the usefulness of using somatostatin receptor scintigraphy in the postresection endoscopy of the tumor and the intraoperative use of a gamma probe detector for the surgical resection of metastatic adenopathy that had not been detected using computed tomography (CT) scanning. METHODS: The patient was studied using CT scanning, somatostatin receptor scintigraphy (SRS), and rectal endoscopic ultrasonography (EUS). A gamma probe detector was scheduled for use during the subsequent surgical intervention. RESULTS: The SRS demonstrated a pelvic metastatic lymphatic node that had not been detected on CT scanning. Additional EUS did not show regional metastatic lymph nodes. Histopathology following removal of retroperitoneal and presacral lymphatic nodes confirmed the diagnosis of metastatic carcinoid tumor. At follow up at 6 months, SRS and rectoscopy were normal. CONCLUSION: Somatostatin receptor scintigraphy is very useful in identifying the presence of lymph node metastases, even with a small rectal carcinoid tumor. This is of considerable importance when scheduling surgery and the CT and EUS are normal. The use of an intraoperative gamma-probe detector assists in the surgical excision of the metastatic lymphatic nodes, especially because they had been detected only using SRS, and when their exact location is uncertain.     

间质磁共振淋巴造影的技术方法及其实验研究

目的探讨间质磁共振淋巴造影对评价正常淋巴系统结构与功能的价值及技术方法。方法选取纯种新西兰大白兔24只,在每只大白兔双侧后肢足背部趾蹼处注射0.2 m l欧乃影,按摩注射部位30 s。分别于造影剂注射之前及注射按摩后5、10、20、30、60、90、120 m in进行三维增强磁共振淋巴造影成像(3D CE-MRL)。测量不同延迟时间引流区域淋巴结的信号强度,绘制时间-信号强度曲线。结果引流区域各组淋巴结、淋巴管及胸导管显示清晰。腘窝淋巴结、腹股沟淋巴结、髂淋巴结/后腹膜淋巴结分别于注射造影剂10 m in、20 m in和30 m in后信号强度达到峰值。双足注射部位未见炎症反应。结论间质磁共振淋巴造影可以有效可靠地显示引流区域淋巴管、淋巴结的解剖形态和功能。     

Sentinel Node Concept in Breast Cancer

BACKGROUND/PURPOSE: It seems that there exists a specific lymph node center called sentinel node (SN) which appears to be the primary site of metastases. The sentinel node concept (SNC) is fundamentally based on the orderly progression of tumor cells within the lymphatic system. It is the most important new concept in surgical and radiation oncology. The purpose is to present the biological significance, the diagnostic and clinical basis of the sentinel node concept in breast cancer patients. MATERIAL AND METHODS: Lymphoscintigraphy and gamma probe biopsy is necessary to show predictable lymph flow to the regional sentinel node, to multiple sentinel nodes or unpredictable lymph flow to extra-regional sentinel nodes and for performing sentinel node procedure. The standard protocol for the evaluation of the sentinel node metastases consists of extensive histopathological investigation including step Hematoxylin & Eosin (H&E) stained sections and immunohistochemistry. RESULTS: A high rate of success of the identification of the sentinel node for breast cancer was reported. The presence or absence of metastasis in this node is a very accurate predictor of overall nodal status. The temptation to examine the sentinel node with the greatest possible degree of accuracy highlights one of the major problems related to sentinel node biopsy. The success of the sentinel node procedure depends primarily on the adequate functional capacity necessary for sufficient uptake to ensure the accurate identification. In negative sentinel-node patients a complete axillary lymph node dissection is avoidable. In sentinel-node positive patients and clinically negative patients a postoperative radiotherapy would permit an adequate tumor control. The last 2 procedures permit a low morbidity. In the actual TNM classification it was recently introduced a definition of a "pN0" patient based on sentinel node biopsy. New target volumes are defined for adjuvant radiotherapy or lymphatic basins could be spared from unnecessary irradiation. CONCLUSION: The sentinel node concept seems to revolutionize the treatment of early breast cancer. Biopsy of the sentinel node is a highly accurate, minimally invasive method of staging patients and can substantially reduce the morbidity and costs of treatment by avoiding unnecessary complete axillary lymph node dissection. The procedure may lead to a more justifiable approach to adjuvant therapy strategies with low complication rates. The identification of the individual lymphatic flow pattern would permit the irradiation of the individual locoregional lymphatic basin.     

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。     

The pathologist's role in sentinel lymph node evaluation

Patients with high-risk (thick, deeply invasive) primary melanoma were, in the past, managed by wide local excision and elective node dissection or wide local excision alone, with subsequent lymphadenectomy if the regional nodes developed clinically detectable metastases. We recently developed a more logical approach called selective lymph node dissection. To be effective, this requires close collaboration of surgeons, pathologists, and nuclear medicine physicians. The draining lymph node basin is identified preoperatively by lymphoscintigraphy. During surgery, a marker dye (isosulfan blue) and radioactive technetium labeled albumin are injected intradermally around the primary melanoma and the afferent lymphatics are followed up to the first lymph nodes of the ipsilateral regional nodal basin. The surgeon excises the blue-colored and maximally radioactive sentinel nodes and the pathologist critically evaluates these for the presence of a metastatic tumor. If the sentinel nodes are tumor free, no further nodal dissection is undertaken; if a tumor is present, a complete dissection of the nodal basin is performed. We have examined 1,119 sentinel lymph nodes from 669 patients treated by selective lymph node dissection. We identified melanoma cells in sentinel nodes from 126 patients (17.8%). A single node contained tumors in 67% of patients, 2 nodes were positive in 25%, and the remaining 12% of patients had three tumor-containing nodes. Melanoma cells were dispersed singly or in variably sized groups, usually in the peripheral nodal sinus. In around 40% of patients, immunohistochemistry is required to identify minute numbers of tumor cells. With experience, pathologists identify tumors in hematoxylin and eosin (H&E) preparations in an increasing proportion of lymph nodes. Tumor cells are more frequent in the sentinel nodes of patients with primary tumors of deeper Clark level and greater Breslow thickness. Tumor cells must be discriminated from capsular nevus cells, interdigitating dendritic leukocytes, macrophages, and intranodal neural tissues.     

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.     

基于 RTOG 分区的颈部淋巴结转移CT 及 MR分析

目的：探讨颈部转移淋巴结分布与其原发肿瘤的相关性,以及其CT、MR影像表现特点,旨在提高病变诊断的准确率。方法搜集经手术或穿刺病理证实的126例原发肿瘤颈部转移淋巴结患者C T和（或）M RI资料,分析颈部转移淋巴结分布与其原发肿瘤的相关性,以及其影像学表现。结果多数头颈部原发肿瘤均可转移到Ⅱb区,Ⅱa区及Ⅲ区也是常见的转移部位。颈部转移淋巴结分布与其原发肿瘤的来源有较大的相关性。结论颈部转移淋巴结分布与其原发肿瘤的淋巴引流区域相关,颈部淋巴结RT OG分区对判断颈部淋巴结转移的原发肿瘤来源具有重要的价值。     

MR Lymphography with a Lymphotropic T1-Type MR Contrast Agent: Gd-DTPA-PGM

A model system of a paramagnetic lymphotropic MR contrast agent (Gd-DTPA labeled polyglucose associated macrocomplex, PGM) for T¹-weighted MR imaging of lymph nodes in rats and rabbits was evaluated. Pharmacokinetic (tissue accumulation) and MR imaging data (optimal dose and timing parameters) were obtained in normal rats (n = 88) after subcutaneous (SC) injection of paramagnetic, radiolabeled [111In]Gd-DTPA-PGM. A rabbit model of lymph node metastases (n = 8) was ultimately used to demonstrate the potential of MR imaging with Gd-DTPA-PGM for nodal tumor detection. Maximum concentrations of Gd-DTPA-PGM were found in popliteal and paraaortic lymph nodes within 24 h after SC administration, and highest lymph node SNR values were obtained by MR imaging at this time point. The optimum imaging dose was 6–12 μmol Gd/kg. Tumor-lymph node contrast increased from 0.0 ± 1.2 precontrast to 19.2 ± 6.5 (spoiled gradient echo sequence, TR 50/TE 7/flip angle 60°) postcontrast and conspicuity of nodal metastases was improved. Gd-DTPA-PGM accumulates in lymph nodes after SC administration and significantly enhances lymph node signal intensity of normal animals but not metastatic lymph nodes.     

Staging of gastric cancer: correlation of lymph node size and metastatic infiltration.

OBJECTIVE: The assessment of lymphatic metastases is an important factor in the staging of gastric cancer. Lymph node size has been used as one criterion for possible nodal metastasis. Although enlarged regional lymph nodes are generally interpreted as metastases, few data are available that correlate lymph node size with metastatic infiltration. MATERIALS AND METHODS: In a prospective morphometric study, the regional lymph nodes from 31 gastrectomy specimens of consecutive patients with primary gastric adenocarcinoma were analyzed. The lymph nodes were counted, the largest diameter of each node was measured, and each node was analyzed for metastatic involvement by histologic examination. The frequency of metastatic involvement was calculated and correlated to lymph node size. RESULTS: A total of 1253 lymph nodes were present in the 31 specimens examined for this study. A mean number of 40 lymph nodes (range, 20-53) were found in each specimen. Of these 1253 nodes, 922 (74%) were tumor-free and 331 (26%) contained metastases. The mean diameter of the lymph nodes free of metastases was 4.1 mm, whereas that of nodes infiltrated by metastases was 6.0 mm (p < .0001). Of the tumor-free lymph nodes, 735 (80%) were less than 5 mm in diameter, whereas 182 (55%) nodes containing metastases were less than 5 mm in diameter. Of the 10 patients without lymph node metastases, seven had at least one node that was 10 mm or greater in diameter; similarly, 15 (71%) of the 21 patients with node metastases had at least one node that was 10 mm or greater in diameter. CONCLUSION: Lymph node size is not a reliable indicator for lymph node metastasis in patients with gastric cancer.     

Clinical experience with intra lymphatic administration of 111In-labelled monoclonal antibody PAY 276 for the detection of pelvic nodal metastases in prostatic carcinoma

The ability of 111In-PAY 276 (anti prostatic acid phosphatase antibody) in detecting pelvic lymph node metastasis following bipedal intra lymphatic administration was studied in five patients with carcinoma of the prostate. The labeled antibody was injected directly into the lymphatics of each foot. Planar and tomographic images radioactivity content of lymph nodes resected during staging pelvic lymphadenectomy were compared to the histologic and immunoperoxidase findings. Radioactivity in pelvic lymph nodes was prominently seen within 20 min of injection and was present 16 days later. Persistent accumulation of tracer in the lymphatics of the lower extremities was also observed in all patients 16 days post injection. Radioactivity counts in tumor-free lymph nodes were higher than in tumored lymph nodes resected. Our results demonstrate that intra lymphatic administration of 111In-labeled PAY 276 monoclonal antibody has major technical limitations, and that further research directed at the causes of tracer accumulation in the lymphatics and tumor-free lymph nodes is required.     

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.     

Interstitial T1-weighted MR lymphography: lipophilic perfluorinated gadolinium chelates in pigs.

PURPOSE: To investigate the enhancement of the regional lymph nodes, lymphatic vessels, and thoracic duct after interstitial administration of lymphotropic perfluorinated gadolinium chelates at magnetic resonance (MR) imaging. MATERIALS AND METHODS: Two perfluorinated gadolinium chelates, gadofluoramide and gadofluorine 8, were injected subcutaneously into the hind legs of 10 pigs, respectively. Both contrast media were studied at doses of 10 and 25 micromol per kilogram of body weight. T1-weighted three-dimensional gradient-echo and maximum intensity projection images were obtained at 1.5 T between 1 and 210 minutes and 24 hours after injection. The contrast agents were qualitatively compared regarding enhancement and depiction of the regional lymph nodes, lymphatic vessels, and thoracic duct. RESULTS: The inguinal and iliac lymph nodes and lymphatic vasculature enhanced substantially within 10 minutes after subcutaneous administration of both lymphotropic contrast agents. Gadofluorine 8 showed a lymphographic effect superior to that of gadofluoramide. The paraaortic lymph nodes and thoracic duct were best visualized 10--50 minutes after injection of 25 micromol/kg of gadofluorine 8. Lymphatic system enhancement diminished after 2 hours, and the liver and bowel tract enhanced within 24 hours. CONCLUSION: Interstitial administration of perfluorinated gadolinium chelates offers great potential for T1-weighted MR lymphography with positive enhancement of the lymph nodes and lymphatic vasculature.