结肠癌术中前哨淋巴结定位的临床意义

目的　探讨术中前哨淋巴结定位在结肠癌手术中的临床意义。方法　对 65例结肠癌患者术中注射亚甲蓝于紧邻肿瘤周围的正常肠壁浆膜下或粘膜下。蓝染的淋巴管术中可肉眼辨认出 ,并可循此寻找已被标记的前哨淋巴结。采用标准方式行结肠癌根治术。所有切除的淋巴结经HE染色 ,每个前哨淋巴结的多张切片经cytokeratin抗体免疫组化染色。 结果　65例患者中有 63例发现SLN ,检出率 96 9%。 93 8% ( 61/65 )的患者的前哨淋巴结能准确地预测其引流区域淋巴结受累情况 ;假阴性 2例 ,假阴性率 7 4% ( 2 /2 7)。 6例患者的前哨淋巴结中包含的微转移灶或单个癌细胞转移被常规HE染色遗漏 ,但是经CK免疫组化染色检出。 7例患者由于发现异常淋巴引流途径而导致肠系膜切除的范围的改变。结论　对结肠癌病例 ,前哨淋巴结定位技术能较准确地预测其引流区域淋巴结受累情况和发现异常淋巴引流途径 ,有助于决定切除范围 ;并且通过指导病理医生有选择性地对前哨淋巴结进行细致的病理检查以提高分期的准确性     

结肠癌术中定位前哨淋巴结的临床研究

目的探讨结肠癌术中定位前哨淋巴结（SLN）的可行性并研究其在结肠癌外科诊疗中的临床意义。方法对73例结肠癌患者进行术中异硫蓝定位检测SLN,术后常规病理检测所有淋巴结,对常规病理检测阴性者进行细胞角蛋白（CK,AE1／AE3）免疫组化检测。结果73例患者中检出SLN72例共157枚,平均每例2．2枚。常规病理检出53例共116枚SLN发生转移。SLN预测区域淋巴结转移状况的敏感性为93．0％,准确性为94．5％。免疫组化检测可以发现微转移,降低淋巴结转移检测的假阴性率。结论结肠癌术中进行SLN定位是可行的,可以发现肿瘤异常淋巴引流,SLN基本可代表区域淋巴结状况,提高术后病理学分期的准确性,但以SLN活检术替代传统术式的可行性和安全性尚需要实施多中心、大样本、前瞻性随机对照研究。     

子宫内膜癌术中前哨淋巴结识别及病理检查的临床意义

目的 探讨子宫内膜癌术中前哨淋巴结(SLN)冰冻病理检查的临床意义.方法 选择行手术治疗的子宫内膜癌患者33例,均行全身静脉麻醉.开腹后,采用5 mL注射器将1％亚甲蓝多点注射于子宫体部浆膜层下,打开腹膜,暴露淋巴引流区域,寻找出最先蓝染的淋巴结即SLN,切取后送冰冻病理检查.此后行子宫、双侧附件、盆腔淋巴结及腹主动脉旁淋巴结清扫术.对20例术中病理检查未见转移的SLN患者,行免疫组化,观察SLN中细胞角蛋白(CK)的表达.结果 33例患者中成功识别摘除SLN 25例(75.8％),其中SLN位于单侧盆腔7例(28.0％),双侧盆腔均有SLN 16例(64.0％),腹主动脉旁2例(8.0％).共识别SLN 67枚,其中闭孔26枚(38.8％),髂内15枚(22.4％),髂外13枚(19.4％),髂总10枚(14.9％),腹主动脉旁3枚(4.5％).有5例(15.2％)患者术中冰冻病理检查证实盆腔内的SLN可见癌组织转移,术后盆腔内其他淋巴结亦可见癌组织转移.术中病理检查未见SLN转移的20例患者中,有1例低分化腺癌并临床Ⅱ期患者经免疫组化染色,1枚SLN内均可见CK阳性表达细胞团,判定为SLN微转移,但在淋巴结清扫中未见癌组织转移.结论 子宫内膜癌患者术中SLN的识别及病理检查对淋巴结清扫范围有指导意义.术后对SLN进行免疫组化染色可以避免假阴性结果.     

乳腺癌前哨淋巴结微转移术中快速检测的临床意义

目的：了解术中冰冻切片联合快速免疫组化在乳腺癌前哨淋巴结（SLN）微转移检测中的应用及效果。方法：2003年2月至2006年4月我科共62例乳腺癌患者，采取美蓝染色前哨淋巴结活检（SLNB），行SLN术中冰冻切片，阴性者行EPOS法快速免疫组化检查以发现微转移。并与术后SLN连续切片及免疫组化检查作比较，以了解快速免疫组化检查的准确性及发现微转移的能力。结果：56例成功行SLNB，成功率90．3％，术中冰冻切片发现20例SLN癌转移，36例阴性者行快速免疫组化检查．发现2例微转移，术后连续切片及常规免疫组化检查又发现2例微转移。结论：美蓝染色SLNB成功率较高、安全、价廉。术中SLN冰冻切片联合EPOS法快速免疫组化检查，可增加SLN微转移的检出率．减少假阴性率．适合基层医院开展。[著者文摘]     

乳腺癌前哨淋巴结中细胞角蛋白19的表达及临床意义

目的 检测乳腺癌前哨淋巴结(SIN)组织中细胞角蛋白19(CK19)在mRNA和蛋白水平的表达情况,以探讨检测淋巴结CK19的表达对预测乳腺癌前哨淋巴结微转移的临床价值.方法 本组30例可手术的原发性乳腺癌患者,手术中均行肿块周围或乳晕周围注射亚甲蓝进行SLN定位成功,同时常规行腋窝淋巴结清扫,术后对SLN和非SLN均行常规病理学检测,对SLN同时采用RT-PCR和Western Blot方法检测CK19的表达.结果 30例SLN常规病理检测发现8例阳性SLN,阳性率为26.67%(8/30),1例假阴性.应用RT-PCR方法和Western Blot方法检测30例SLN中CK19的表达,结果HE染色阳性的8例SLN及1例假阴性SLN均呈阳性表达,共有12例SLN CK19mRNA表达阳性,阳性率为40.0%(12/30);Western Blot检测发现1I例SLN CK19呈阳性,阳性率为36.67%(11/30).RT-PCR、Western Blot检测结果分别与HE染色结果比较,差异均有统计学意义(P<0.05),假阴性率为0.结论 CK19mRNA可作为标志物来检测乳腺癌SLN中的微转移情况;RT-PCR方法可检测到SLN微转移灶,通过SLN定位后检测其中CK19mRNA的阳性表达,可明显提高乳腺癌SLN的阳性率,降低SLN单纯病理检测的假阴性率.     

中低位直肠癌前哨淋巴结定位活检的可行性研究

目的：通过联合纳米炭（carbon nanoparticles,CNP）和^99mTc-硫胶体（^99mTc-sulfur colloid,TSC）对腹膜返折上、下方直肠癌前哨淋巴结（sentinel lymph node,SLN）定位活检,探讨中低位直肠癌SLN活检的可行性。方法：25例直肠癌患者（10例癌位于腹膜返折上、15例癌位于腹膜返折下）,术中于瘤周浆膜下或粘膜下注射CNP和TSC行SLN定位活检。对检出的SLN行常规HE染色病理学检查,若为阴性则加行细胞角蛋白20（cytokratin20,CK20）免疫组化检测,并比较两组检出率、灵敏度的差异。结果：5例直肠癌患者SLN的检出率为96％（24／25）,每例检出1～4个SLN,平均2个。SLN判断结直肠癌区域淋巴结转移状态的灵敏度为91．67％,假阴性率为11．77％。两组检出率及灵敏度均无统计差异。在15例常规HE染色检测SLN阴性的患者中有3例CK20免疫组化检测阳性。结论：中低位直肠癌SLN活检是可行的。应依据肿瘤部位的不同分别选用粘膜下或浆膜下注射CNP和TSC行直肠癌前哨淋巴结活检。     

亚甲蓝和99mTc-硫胶体联合定位技术在结直肠癌前哨淋巴结检测中的应用价值

目的:探讨亚甲蓝和~(99)锝硫胶体(~(99m)Tc sulfur colloid,TSC)联合在体结直肠癌前哨淋巴结(sentinel lymph node,SLN)定位的可行性。方法:15例结直肠癌根治术患者,术中行亚甲蓝和TSC联合定位并活检SLN。对常规病理学检查阴性的SLN加行细胞角蛋白20(cytokratin 20,CK_(20))免疫组化检测。结果:15例结直肠癌患者SLN的检出率为80%(12/15),每例检出1～4个SLN,平均2个。SLN判断结直肠癌区域淋巴结转移状态的准确率为91．7%,灵敏度为50%,阴性预测值为90．9%,假阴性率为8．3%。在11例常规HE染色检测SLN阴性的患者中有2例CK20免疫组化检测阳性。结论:亚甲蓝和TSC联合在体定位检测结直肠癌SLN对于预测结直肠癌患者区域淋巴结的转移状态具有潜在价值。     

甲状腺癌前哨淋巴结微转移分子检测及其临床意义

目的探讨甲状腺癌前哨淋巴结活检(SLNB)的可行性及临床意义,探索逆转录聚合酶链反应(RT-PCR)技术对诊断前哨淋巴结微转移灶的价值。方法对21例甲状腺癌患者应用亚甲蓝染色法行SLNB,对SLN进行HE染色、细胞角蛋白19(CK19)的免疫组化染色(IHC)及RT-PCR检测,比较3种方法对SLN微转移灶检出的敏感性、准确率的差异。结果21例中,成功检出SLN 16例,检出率为76.2%。IHC、RT-PCR与HE比较差异有统计学意义。结论前哨淋巴结活检可有效判断甲状腺癌转移状态,应用RT-PCR检测CK19在SLN中的表达,可提高敏感度及准确率。     

前哨淋巴结活检在乳腺癌中的临床研究

目的：探讨肿瘤前哨淋巴结活检在乳腺癌中应用的可行性。方法；采用术中注射亚甲蓝方法定位前哨淋巴结，对40例乳腺癌行腋窝蓝染淋巴结活检，后行常规腋窝淋巴结清扫，两标本均送病理检查。结果：全组40例患者检出SLN36例，4例未找到SLN，检出率为90％（36／40）；SLN与ALN病理检查完全符合者37例，准确率为92．5％（37／40）；出现淋巴结转移的有16例，其中SLN出现转移的有12例。灵敏度为75％（12／16）；假阴性率为25％（4／16）。T1期20例无假阴性者，准确率100％，T2期20例假阴性者4例，准确率为80％（16／20），假阴性率为20％（4／20）。淋巴结阴性病例前哨淋巴结检出率100％（24／24）明显高于淋巴结阳性者的病例75％（12／16）。结论：前哨淋巴结活检能准确预测乳腺癌腋窝淋巴结状态，术中注射亚甲蓝方法定位前哨淋巴结可以作为检测SLN的常用方法之一。淋巴结阴性的病例前哨淋巴结检出率明显高于淋巴结阳性者的病例。     

应用RT-PCR检测乳腺癌前哨淋巴结微转移的研究

目的评价前哨淋巴结（SLN）活检及其微转移检测临床意义。方法本组46例原发性乳腺癌患者，应用美蓝进行前哨淋巴结定位和活检，随后行腋窝淋巴结清扫（ALND），行SLN、腋淋巴结（ALN）中CK19的RT-PCR检查。结果46例乳腺癌患者中，41例检测到SLN（89．1％），SLN的成功定位活检与肿瘤大小有关。对上述41例的SLN的常规病理检查的敏感性是75％，准确性是90．2％，假阴性25％。在行RT-PCR检查中，敏感性是96％，准确性是97．6％，假阴性4％。结论RT—PCR法较常规病理更为敏感，通过SLN定位和RT-PCR的联合应用，可明显提高乳腺癌淋巴结微转移的检出率。     

Measurement of lymph node function from the extraction of immunoglobulin in lymph

Abstract

Background. We aimed to measure the extraction fraction of human immunoglobulin G (HIG) by the 1st echelon lymph node (sentinel node) following intradermal injection in patients with breast cancer undergoing axillary lymph node dissection (ALND) and examine its association with node size and presence and extent of nodal metastatic disease. Materials and methods. HIG labelled with either In-111 (n = 21) or Tc-99m (n = 9) was injected intradermally at the areolar. ALND was performed 2–4 h later. All lymph nodes were isolated and individually counted in a well-counter. The counts in the ‘hottest’ (1st echelon) node were expressed as a fraction of total counts in all the resected nodes. Since counts in the least hot nodes barely exceeded background, this fraction represents extraction fraction for the 1st echelon node. Presence of disease was noted in each 1st echelon node and the extent quantified as percentage replacement with disease. Results. Median extraction fraction in 1st echelon nodes with no or low (<1%) disease burden (n = 21) was 68 (range 23–93)%, significantly higher (p<0.05) than in diseased 1st echelon nodes (n = 9), in which it was 44 (21–66)%. There was, however, no association between extraction fraction in diseased nodes and disease extent. In nodes with no/low disease, extraction fraction was similar for the two radiolabels. There was no association between extraction fraction and node size. Conclusion. Nodal extraction fraction of HIG is a novel physiological measurement. It is reduced as a result of metastatic invasion. In the absence of disease, it shows no correlation with node size.     

前哨淋巴结转移阳性对非前哨淋巴结转移的预测效能研究

目的探讨前哨淋巴结转移阳性对非前哨淋巴结转移的预测效能。方法选择前哨淋巴结活检的乳腺癌患者共157例,检测前哨淋巴结转移情况,并分析前哨淋巴结转移阳性对非前哨淋巴结转移的预测效能。结果 157例患者共检出前哨淋巴结341枚,共发现转移的前哨淋巴结87枚。共清除非前哨淋巴结2 281枚,发现转移共301枚。非前哨淋巴结假阴性率为9.76%(8/82),其敏感度为95.12%(78/82),特异性为87.23%(81/94),准确度为87.26%(137/157)。结论前哨淋巴结转移阳性对非前哨淋巴结转移具有较好的预测效能。     

Mucocutaneous lymph node syndrome

Mucocutaneous lymph node syndrome (MLNS) is a recently described disease entity of unknown etiology that mainly affects children. The disease is characterized by fever, oral mucosal changes, cervical lymphadenopathy and a peripheral skin rash with induration of hands and feet and subsequent desquamation. Thromboarteritis of the coronary vessels causes death in 1 to 2 percent of the patients. Over 7,000 cases have been reported in Japan and increasing numbers are reported in the United States. No specific treatment is available.     

Temocillin in peripheral lymph

One gram of temocillin was given intravenously to five healthy volunteers to study the concentrations in serum and peripheral lymph obtained by cannulation of the lower leg. The 1 h serum level was 58.1 mg/l and the lymph level 14.3 mg/l. The mean peak lymph concentration was 30.6 mg/l and occurred between 1.5 and 2 h; the simultaneous serum level was 47.8 mg/l. The antibiotic levels in lymph were always below those in serum. The urinary recovery over 12 h was nearly 60%. The mean ratio between the areas under the concentration curves of lymph and serum was 0.558. The serum half-life was 4.9 h, the apparent beta-phase distribution volume 18.41. In comparison, the lymph half-life was 4.4 h. Protein binding appears to be of little consequence to the ability of temocillin to penetrate well into extravascular foci.     

Antibody formation by single cells from lymph nodes and efferent lymph of sheep

The antibody-forming cells which appear in the popliteal lymph node and efferent lymph of the sheep following immunization with boiled Salmonella have been studied by light and electron microscopy. Cells were incubated in monolayers with target erythrocytes sensitized with bacterial lipopolysaccharide. Three types of interaction between a proportion of the lymph cells and the erythrocytes surrounding them have been shown to indicate antibody formation: plaque-formation, immuno-cyto-adherence, and localized agglutination. At the peak of the response, 4 days after antigenic stimulation approximately 1 cell in every 200 from lymph node suspensions produces detectable specific antibody, while up to 1 cell in 20 in the lymph is active. For light microscope examination, individual antibody-forming cells were smeared in serum and stained with Leishman''s stain. For electron microscopy, a number of active cells were clumped with antiserum to form a specimen of convenient size, then sectioned. Most of the active cells from efferent lymph are large and basophilic, while a small proportion are blastlike. These cells contain abundant free ribosomes and very little endoplasmic reticulum. In the node only, an additional class of antibody-forming plasma cells is found which have considerable amounts of endoplasmic reticulum in their cytoplasm.