临床颈淋巴结转移阴性舌体鳞癌前哨淋巴结临床研究

目的 探讨舌体鳞癌前哨淋巴结（SLN）的检测及其对颈淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法，对21例未经治疗的舌体鳞癌颈淋巴结N0的患者手术中取SLN作快速冰冻病理检查，并与术后常规石蜡切片病理检查对照．观察冰冻病理检查前哨淋巴结转移与常规病理检查颈淋巴结转移的相关性及其对颈淋巴结转移癌的预测准确率。结果 21例中15例成功地显示SIN，且全部集中在Ⅰ、Ⅱ、Ⅲ区，21例中6例出现颈淋巴结转移且均为SLN转移，SLN活检对颈淋巴结转移的阳性预测准确率为6／6。结论 前哨淋巴结尤其是Ⅰ、Ⅱ、Ⅲ区淋巴结检测对判定舌体鳞癌CN0患者的颈淋巴结有否转移具有重要的预测价值。     

翻瓣对舌引流淋巴结染色定位影响的动物实验研究

目的：探讨注射染料前翻瓣对提高舌引流第一站淋巴结检出率的意义，为临床规范染色法舌癌前哨淋巴结活检方式提供依据。方法：64只成年兔按注射部位随机均分为舌尖、舌侧缘、舌中央和舌根4组；分0．1、0．2、0．3、0．4m14种美兰注射剂量，每种剂量注射上述每个部位组4只，各2只分别于手术翻瓣前、后进行；记录每次实验引流淋巴管、结开始蓝染时间和排空时间以及引流第一站淋巴结检出情况。结果：64例中60例检出蓝染淋巴结，总成功率为93．75％。注射美兰前翻瓣组均能记录到引流淋巴管、结开始蓝染时间；注射美兰后翻瓣组则不能记录到。未见颈浅淋巴结染色；蓝染的淋巴结均位于Ⅰ-Ⅲ区。结论：美兰作舌癌前哨淋巴结示踪剂是可靠的。舌癌前哨淋巴结不出现于颈浅淋巴结中，故注射美兰前翻瓣不会影响前哨淋巴结染色，可缩短手术寻找前哨淋巴结时间、提高检出率。     

老年口腔鳞癌前哨淋巴结活检的临床病理研究

目的:探讨前哨淋巴结活检(sentinel lymph node biopsy,SLNB)预测老年口腔鳞癌患者颈部淋巴结转移的价值及提高病理准确性的方法。方法:对18例临床及影像学检查阴性的老年口腔鳞癌患者,采用1%美兰示踪定位识别前哨淋巴结,随后行全颈淋巴结清扫,将SLN做连续病理切片检查。结果:18例患者中检出SLN14例,其中13例的SLN能准确预测颈部淋巴结的转移状况。结论:应用美兰能准确定位SLN,前哨淋巴结连续病理切片活检结果,能准确预测颈部淋巴结的转移状况,具有潜在的临床应用价值。     

前哨淋巴结SPECT显像在老年口腔鳞癌隐匿转移中的评价

目的：探讨术前前哨淋巴结（SLN）的同位素显像（SPECT）在老年口腔鳞癌颈部隐匿转移中的诊断价值。方法：选择临床检测淋巴转移阴性的老年患者20例,肿瘤旁粘膜下注射99Tcm标记的右旋糖酐（DX）术前淋巴显像定位SLN,对SLN和非SLN采用连续病理切片行常规病理检测,对比SLN和非SLN淋巴结转移数据。结果：同位素淋巴显像法检测出17例口腔鳞癌的SLN共计36枚,平均2.3枚,SLN检测转移阳性5例,其中1例同时伴NSLN转移.未发现单独的NSLN转移。结论：同位素显像（SPECT）对前哨淋巴结（SLN）具有较高的检出率,前哨淋巴结（SLN）的检测结果可真实反映cN0期老年口腔鳞癌隐匿转移中的状况.     

舌癌前哨淋巴结活检的临床研究

目的　探索前哨淋巴结 (sentinelnode ,SN)活检能否准确评价舌癌颈淋巴结转移状况及其适应范围。方法　使用术前核素扫描法和术中亚甲蓝示踪法对临床N0 (cN0 )舌癌 2 0例和临床N (cN )舌癌 5例进行SN示踪 ,对比SN和颈清扫标本石蜡切片病理结果。结果　全组 2 5例检出SN 2 4例 ,检出率为 96 % ,共 5 3个 ,平均每例 2 2个 ;cN0 组 2 0例全部检出SN并准确评价颈淋巴结转移状况 ;cN 组 5例中检出SN 4例 ,4例中cN 颈部 5侧 ,其中有 4侧检出SN ,2侧为假阴性 ,cN0颈部 3侧中 2侧检出SN ,均为SN pN 。结论　核素扫描法和生物染料法结合能有效地对舌癌进行SN示踪 ;SN活检能准确地评价cN0 舌癌颈部淋巴结转移状况 ;能否用于评价cN 病例的cN0 侧颈部淋巴结转移状况需进一步研究。     

SPECT/CT同机融合显像在口腔鳞癌前哨淋巴结定位中的应用

目的　探索一种准确、实用的口腔鳞癌前哨淋巴结定位方法。方法　术前运用SPECT/CT同机融合显像技术对30例cN0期口腔鳞癌患者的SLN进行定位,术中对定位的SLN活检,术后比较SLN与颈淋巴清扫的病理结果。结果　全组病例中,SPECT/CT同机融合图像对SLN定位的准确度为100%, 8例患者的前哨淋巴结和颈清扫淋巴结病理结果证实有癌转移,前哨淋巴结活检对颈部淋巴结转移状况评价的敏感度、特异度和准确度均为100%。结论　SPECT/CT同机融合显像技术可以在术前准确定位前哨淋巴结,客观评价cN0期口腔鳞癌患者颈部淋巴结的真实状况。     

前哨淋巴结活检术诊断口腔鳞癌淋巴结隐匿性转移的研究进展

前哨淋巴结活检术是诊断cN_0口腔鳞癌患者颈淋巴结隐匿性转移的新手段,采用蓝色染料定位法、核素示踪法定位前哨淋巴结,对其进行病理学检查,可较精确地预测区域性淋巴结转移。该技术成功率达到 95％～100％,敏感度达到80％,阴性预测率达到100％,这对医生决定是否对患者进行选择性颈清扫术具有重要意义。     

前哨淋巴结活检术诊断口腔鳞癌淋巴结隐匿性转移的研究进展

前哨淋巴结活检术是诊断cN0口腔鳞癌患者颈淋巴结隐匿性转移的新手段，采用蓝色染料定位法、棱素示踪法定位前哨淋巴结，对其进行病理学检查，可较精确地预测区域性淋巴结转移。该技术成功率达到95％-100％，敏感度达到80％，阴性预测率达到100％，这对医生决定是否对患者进行选择性颈清扫术具有重要意义。     

cN0舌鳞癌颈部Ⅲ区、Ⅳ区淋巴结的微小转移分析

目的 分析临床颈部阴性（cN0）舌鳞癌患者的颈部Ⅲ区、Ⅳ区淋巴结微小转移情况。方法 采用角蛋白免疫组化染色结合半连续切片技术,对25例cN0舌鳞癌颈部Ⅲ区、Ⅳ区的471个淋巴结进行复查。结果 常规病理检查证实有转移的11个位于Ⅲ区的阳性淋巴结,角蛋白免疫组化染色均能检出;在常规病理检查为阴性的460个淋巴结中,角蛋白免疫组化染色结合半连续切片技术,仅在1个Ⅲ区淋巴结中检出一个2.0 mm×1.5 mm的微转移灶,在Ⅳ区淋巴结中未检出微转移灶。结论 cN0舌鳞癌Ⅳ区淋巴结转移率很低,对所有的cN0舌鳞癌患者均清扫Ⅳ区似无必要。     

cN0口腔鳞癌颈部Ⅱb区淋巴结的微小转移分析

目的 :探讨c N0口腔鳞癌患者颈部Ⅱb区淋巴结的微小转移情况。方法 :对94例c N0口腔鳞癌患者颈部淋巴结清扫术后标本中的419枚Ⅱb区淋巴结半连续切片,进行角蛋白免疫组化染色检查分析。结果:419枚Ⅱb区淋巴结中,常规病理检查为阳性的2枚转移淋巴结,角蛋白免疫组化染色检查结果均呈阳性;其余417枚常规病理检查为阴性的淋巴结中,仅有1枚淋巴结发现了两处约为1.0 mm×0.5 mm及0.7 mm×0.8 mm大小的微小转移灶。结论:c N0口腔鳞癌颈部Ⅱb区淋巴结的转移率很低,建议早期c N0口腔鳞癌患者行择区性颈淋巴结清扫术时保留颈部Ⅱb区淋巴组织。     

Outcome of sentinel lymph node biopsy in early-stage squamous cell carcinoma of the oral cavity with methylene blue dye alone: a prospective validation study

Our aim was to evaluate the feasibility and role of sentinel lymph node (SLN) biopsy using methylene blue dye alone in identifying occult lymph node metastases in early oral cancer (cT1, T2, and cN0). The study was done from 2013–15 in 94 patients in a large cancer centre. The blue nodes were dissected and sent for frozen section, routine histopathological examination, and immunohistochemical testing for cytokeratin, and was followed by elective neck dissection in all patients. The identification rate was 93.61%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for frozen section and haematoxylin and eosin (H&E) staining were 84.6%, 100%, 100%, 93.9% and 95.5%, respectively. Occult lymph node metastasis was seen in 27.6% cases. Biopsy of SLN with blue dye alone might be used successfully with good sensitivity and negative predictive value in countries with limited resources in the developing world. Immunohistochemistry contributes to it by increasing the sensitivity and NPV, and thereby improves the diagnostic value.     

兔舌癌哨位淋巴结C/Gd复合物间质磁共振造影的实验研究

目的:探讨新型显影剂C/Gd纳米复合物间质磁共振造影（IMRLG）诊断兔VX2舌癌模型颈部哨位淋巴结转移的应用价值。方法:将VX2癌组织块植入16只健康新西兰大白兔左侧舌缘。25 d后,于兔双侧舌缘黏膜下注入造影剂C/Gd纳米复合物0.25 mL。分别于注射前及注射后5、10、15、20、30、40 min及24 h进行磁共振淋巴成像。计算特定时间节点的信号强化率(E%),定位哨位淋巴结,观察淋巴系统。注射造影剂24 h后,于双侧舌下黏膜注射0.2 mL亚甲蓝,行活体淋巴染色,解剖颈部淋巴结,行组织病理学检查。采用SPSS19.0软件包对数据进行统计学分析。结果:成功建立兔VX2舌癌模型16只（16/16）,其中发生淋巴结转移16只（16/16）。注射造影剂后10 min,肿瘤侧与对照侧淋巴结磁共振成像的E%具有显著差异（P<0.05）。IMRLG判断转移哨位淋巴结18个,在亚甲蓝活体染色下,解剖出淋巴结32个,其中病理学检测转移淋巴结17个,IMRLG的准确率为94.45%（17/18）,两者诊断SLN转移无统计学差异（P>0.05）。结论:应用C/Gd纳米复合物行IMRLG,可较准确地判断兔舌癌哨位淋巴结状况,为判断舌癌淋巴结转移提供了新的思路,有潜在应用价值。     

淋巴显像技术在口腔鳞癌哨位淋巴结活检中的应用

目的:评价淋巴显像技术在口腔鳞癌哨位淋巴结活检中的价值。方法:应用颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术,对21例临床NO(cNO)口腔鳞癌患者的哨位淋巴结(sentinel lymph node,SLN)进行研究。结果:全组患者SLN检出率为100％,21例中有7例SLN活检阳性,颈清术后标本同样证实有颈淋巴结转移,无假阴性结果,SLN活检对全组病例颈淋巴结转移状况预测的准确性为100％。结论:颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术能有效地对口腔鳞癌SLN进行定位,从而准确预测颈淋巴结转移状况。     

Preliminary study of indirect CT lymphography-guided sentinel lymph node biopsy in a tongue VX2 carcinoma model

The feasibility of using indirect CT lymphography (CT-LG) to guide sentinel lymph node (SLN) biopsy in a rabbit model of tongue VX2 carcinoma with cervical lymph node metastasis was studied. Tongue VX2 carcinoma with cervical lymph node metastasis was induced in 19 rabbits by injecting VX2 carcinoma suspension into the tongue submucosa. SLN biopsy was performed under the guidance of indirect CT-LG. SLN identification was performed by indirect CT-LG combined with blue dye injection in 2 rabbits. Tongue SLNs were identified preoperatively by indirect CT-LG and blue-stained SLNs were visualized intraoperatively. Only one SLN was enhanced in each side of the neck, lateral to the larynx-tracheal region. CT attenuation values of the enhanced SLNs were 782.4 ± 46.6, 443.1 ± 68.5, 180.3 ± 20.6 and 80.5 ± 10.7 HU at 1, 5, 15 and 20 min after contrast injection. Overall, ipsilateral SLN identification rate was 97.4% and contralateral SLN identification rate was 100%. Ipsilateral SLN metastasis was verified in all rabbits (100%), bilateral SLN metastasis occurred in 8 rabbits (42%), and micrometastasis was found in 3 rabbits (16%). Indirect CT-LG may be useful for guiding SLN biopsies in tongue cancer. Combining indirect CT-LG with blue dye injection may improve preoperative and intraoperative SLN identification.     

Sentinel lymph node biopsy with preoperative CT lymphography and intraoperative indocyanine green fluorescence imaging for N0 early tongue cancer: A long-term follow-up study

PurposeThis study evaluated the usefulness of sentinel lymph node (SLN) biopsy with preoperative computed tomographic lymphography (CTL) and intraoperative indocyanine green (ICG) fluorescence imaging for N0 early tongue cancer.MethodsTwenty-seven patients with N0 early oral tongue cancer underwent CTL with a 128-slice multi-detector row CT scanner to detect SLN on the day before resection of primary tumor and SLN biopsy under ICG fluorescence guidance. We identified the location and number of SLNs mapped by CTL and evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. Prognosis was also evaluated.ResultsSLNs were detected by CTL in 26 of 27 patients (96.3%). The total and mean numbers of SLNs were 41 and 1.5, respectively. All SLNs enhanced by CTL could be identified intraoperatively as ICG fluorescent lymph nodes. Two SLNs were found under ICG fluorescent guidance in only one patient without SLN enhanced by CTL. Among the 27 patients, five (18.5%) had SLN with metastasis. Median follow-up was 76 months (range 44–82 months). During follow-up, three of 22 patients without SLN metastasis had occult cervical lymph node metastasis. The 5-year overall survival rate was 100%.ConclusionSLN biopsy with preoperative CTL and intraoperative ICG fluorescence imaging is a feasible and reliable procedure, without radioisotope tracers, for neck management in cases of early tongue cancer.     

舌癌患者非前哨淋巴结转移的预测因素

目的探讨舌鳞癌患者非前哨淋巴结（non-sentinel lymph node,nSLN）转移的预测因素。方法回顾性分析采用单光子发射计算机断层成像术和螺旋CT融合显像技术及蓝染法示踪定位前哨淋巴结（sentinel lymphnode,SLN）活检中存在转移的38例患者,对nSLN进行常规HE染色和CK免疫组化检查,研究nSLN转移与各种临床病理因素的关系。结果当SLN（＋）转移灶最大直径大于2 mm时,nSLN转移率为64.7%（11/17）;当SLN（＋）数目为1时,nSLN转移率为64.3%;当SLN（＋）数目为2时,nSLN转移率为20.0%;当SLN（＋）数目大于等于3时,nSLN转移率为11.1%。nSLN转移率随着肿瘤原发灶浸润深度的增加而增大。结论 nSLN是否转移与SLN（＋）转移灶最大直径、SLN（＋）数目和肿瘤原发灶浸润深度有关。