Is Blue Dye Indicated for Sentinel Lymph Node Biopsy in Breast Cancer Patients With a Positive Lymphoscintigram?

Background The use of isosulfan blue dye in sentinel node biopsy for breast cancer has been questioned because of its risk of allergic reaction. We hypothesized that blue dye could be safely omitted in the subgroup of patients who have evidence of successful sentinel node localization by lymphoscintigraphy.Methods A retrospective review of patients with breast cancer and sentinel node biopsy was conducted. Information was collected on lymphoscintigraphy results, use of blue dye, and intraoperative and pathologic findings of sentinel nodes.Results We identified 475 patients with breast cancer who underwent 478 sentinel node biopsies. Both dye and isotope were given in 418 cases, of which 380 had a positive lymphoscintigram. In 5 of the 380 cases with a positive lymphoscintigram, the sentinel nodes obtained were blue but not hot, for a 1.3% marginal benefit of dye in the technical success of the procedure. Sentinel nodes positive for metastasis were found in 102 of 380 cases; in 3 cases, the only positive sentinel node was blue but not hot. Omission of the blue dye tracer would have increased the false-negative rate of the sentinel node procedure by approximately 2.5%.Conclusions Even in sentinel node biopsy cases with a positive lymphoscintigram, the use of blue dye is beneficial for both improving the technical success of the procedure and reducing the false-negative rate of the procedure. Because the marginal benefits of dye justify its routine use, strategies to minimize the toxicity of blue dye are warranted.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

Indocyanine green fluorescence method for sentinel lymph node biopsy in breast cancer

Background/ObjectiveBreast biopsy and analysis of sentinel lymph nodes (SLNs) accurately predict tumor status in the affected basin and help in avoiding unnecessary axillary lymph node dissection, which is associated with remarkable morbidity risk. Blue dye and radioisotope are the most widely used mapping agents, but non-radioactive tracers of comparable accuracy warrant further investigation. This study aimed to investigate utilization of indocyanine green (ICG) fluorescence in sentinel node localization compared with blue dye and to assess the incremental value of ICG.MethodsA total of 39 consecutive patients underwent sentinel lymph node biopsy (SLNB) (40 cases: 38 unilateral and 1 bilateral) with combined blue dye and ICG for localization. The obtained fluorescence images of the lymphatic system were investigated.ResultsAll 84 lymph nodes removed in 40 procedures were identified by ICG, but only 37 were identified by blue dye. The ICG method identified an average of 2.1 SLNs in 39 of 40 cases with a detection rate of 97.5%, but only 0.93 SLN per case with blue dye. Subcutaneous lymphatic channel patterns were also detected by fluorescent imaging in 37 procedures, which all revealed lymphatic drainage toward the axilla except in one case with internal mammary pathway.ConclusionThis study demonstrated the accuracy and safety of ICG for SLNB and its superiority to blue dye method in SLN localization. Therefore, ICG fluorescence method is safe and effective addition in breast clinical settings, wherein blue dye alone is used.     

Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?

BACKGROUND: Controversy exists in sentinel lymph node (SLN) mapping in breast cancer regarding the appropriate number of nodes to remove and the best technique for identification of the SLNs. METHODS: A retrospective chart review from January of 1999 to January of 2004 was performed for all patients undergoing a SLN biopsy examination who had at least 1 positive SLN. RESULTS: We identified 167 patients. A mean of 4.4 SLNs were removed per patient. All of the positive SLNs were identified by node 6. Radiotracer used alone identified 19 positive nodes (11.4%) and blue dye used alone identified 14 positive nodes (8.4%). CONCLUSIONS: Our data show that 100% of positive SLNs are found by 6 nodes removed, thereby supporting the concept that the SLN dissection may not be complete by removing only 1 or 2 nodes or only the hottest node. The use of blue dye or radiotracer alone can contribute to the overall false-negative rate.     

Role of Combined Sentinel Lymph Node Biopsy and Axillary Node Sampling in Clinically Node-Negative Breast Cancer

Axillary lymph node status is a prognostic marker in breast cancer management, and axillary surgery plays an important role in staging and local control. This study aims to assess whether a combination of sentinel lymph node biopsy (SLNB) using patent blue dye and axillary node sampling (ANS) offers equivalent identification rate to dual tracer technique. Furthermore, we aim to investigate whether there are any potential benefits to this combined technique. Retrospective study of 230 clinically node-negative patients undergoing breast-conserving surgery for single T1–T3 tumours between 2006 and 2011. Axillae were staged using a combined blue dye SLNB/ANS technique. SLNs were localized in 226/230 (identification rate 98.3 %). Three of one hundred ninety-two patients with a negative SLN were found to have positive ANS nodes and 1/4 failed SLNB patients had positive ANS nodes. Thirty-four of two hundred twenty-six patients had SLN metastases and 11/34 (32.4 %) also had a positive non-sentinel lymph node on ANS. Twenty-one of twenty-four (87.5 %) node-positive T1 tumours had single node involvement. Nine of thirty-eight node-positive patients progressed to completion axillary clearance (cALND), and the rest were treated with axillary radiotherapy. Axillary recurrence was nil at median 5 year follow-up. Complementing SLNB with axillary node sampling (ANS) decreases the unavoidable false-negative rate associated with SLNB. Appropriate operator experience and technique can result in an SLN localization rate of 98 %, rivalling a dual tracer technique. The additional insight offered by ANS into the status of non-sentinel nodes has potential applications in an era of less frequent cALND.     

Methylene Blue Dye as an Alternative to Isosulfan Blue Dye for Sentinel Lymph Node Localization

Background: Our study describes the use of methylene blue dye as an alternative to isosulfan blue dye to identify the sentinel lymph node (SLN).Methods: A retrospective analysis was performed of 112 breast cancer patients (113 axillae) who underwent SLN biopsy (SLNB) with methylene blue dye and ^99mTc-labeled sulfur colloid for SLN identification. All SLNs were submitted for intraoperative frozen section analysis, hematoxylin and eosin stain, and immunohistochemical evaluation. Patients with a pathologically negative SLN did not undergo further axillary lymph node dissection.Results: Of 112 patients who underwent SLNB, the SLN was identified in 107 (95.5%); 104 (92.8%) were identified by methylene blue dye. In a subset of 99 patients with recorded isotope status in relation to blue nodes, concordant identification with both dye and isotope was observed in 94 (94.9%). Of patients with identified SLNs, 32 (29.9%) of 107 contained metastatic disease, with 31 (96.9%) of 32 identified by methylene blue dye. The SLN was the only positive node in 18 (60.0%) of 30 patients.Conclusions: SLNB with methylene blue dye is an effective alternative to isosulfan blue dye for accurately identifying SLNs in breast cancer patients.Presented at the Society of Surgical Oncologys 55th Annual Cancer Symposium, Denver, Colorado, March 14–17, 2002.     

乳腺癌前哨淋巴结解剖学定位的临床研究

目的:探讨示踪剂注射部位对乳腺癌前哨淋巴结(sentinel lymph node,SLN)定位的影响。方法:对53例cN0期乳腺癌患者行核素示踪联合染料染色示踪法检测SLN,在原发肿瘤表面的皮下组织内或切除活组织检查残腔肿瘤周围两点注射99m锝(99mTc)标记的硫胶体,将卡纳琳或亚甲蓝分别注射于肿瘤对角线相应部位的皮下组织内(30例)或乳头乳晕下皮下组织内(23例)。SLN活组织检查后再行腋窝淋巴结清除术,标本行常规HE染色组织学检查。结果:53例患者均成功检测出SLN,核素示踪法与蓝染料法的成功率均为96.23%(51/53),联合检测的成功率100%(53/53),共检出SLN103枚,平均每例检出1.94枚,其中50例SLN位于胸大肌外侧缘的外侧组淋巴结(LevelⅠ),1例位于胸小肌后(LevelⅡ),1例同时位于LevelⅠ及LevelⅡ,1例同时位于LevelⅠ及胸骨旁。全部病例蓝染料与核素示踪标识的SLN均为同一枚(或同一组)淋巴结,两者完全吻合;且蓝染料注射于乳头乳晕或肿瘤对角线部位与核素注射于肿瘤周围所标识的SLN也完全一致。结论:SLN可能是乳房整个器官的SLN,而非乳房某个具体部位的SLN,与示踪剂的注射部位无关。     

结直肠癌前哨淋巴结体外标记的研究

目的探讨结直肠癌前哨淋巴结（SEN）体外亚甲蓝定位活检方法的可行性，研究前哨淋巴结组织学状况能否用于预测区域淋巴结转移情况。方法将32例手术切除的结直肠癌标本纵行剪开，在癌肿四周注射亚甲蓝，2—5min后沿着蓝染的淋巴管追踪寻找首先蓝染的前哨淋巴结。将其切下后单独进行病理切片，检测有无癌转移，并与系膜淋巴结病理结果予以比较。结果有30例标本成功显示57枚SLN，平均每例标本显示1．9枚SLN。在SLN阳性的13例患者中。5例非SLN呈阳性，8例非SLN呈阴性；在17例SLN为阴性的标本中，15例非SLN呈阴性，仅2例非SLN呈阳性。统计本组患者SLN标记成功率为93．8％（30／32），准确率为93．3％（28／30），假阴性率为11．8％（2／17），特异性为100％（13／13）。结论结直肠癌标本前哨淋巴结体外亚甲蓝标记法可行，其组织学状况可较准确反映区域淋巴结群的癌转移情况。     

乳腺癌患者腋窝前哨淋巴结微转移及孤立癌细胞的评价

目的 评价连续切片及免疫组化技术在乳腺癌前哨淋巴结(SLN)转移诊断中的价值,探讨微转移和孤立癌细胞的临床意义.方法 对80例腋窝淋巴结阴性的乳腺癌患者,用99mTc-SC和异硫蓝联合法进行前哨淋巴结活检(SLNB),对所有SLN和非SLN进行常规HE染色及免疫组织化学分析.结果 78例(97.5%)成功检出SLN,其中76.5%的SLN同位素和染料检查均为阳性.32例(41%)SLN转移阳性,其中13例(40.6%)为微转移.共有14例(43.8%)患者SLN是惟一阳性的淋巴结.SLN预测腋窝状态的敏感性、特异性和准确性分别为96.9%,100%和98.7%.SLN转移的患者,其SLN之外的转移率明显高于仅有微转移的患者(78.9%vs.23.1%).结论 连续切片及免疫组化技术是乳腺癌SLN转移诊断的敏感方法.仅有SLN微转移患者的SLN之外的腋窝淋巴结转移率低,但其预后意义及对手术方案的影响尚待进一步研究.     

Sentinel node biopsy using dye and isotope double tracers in early gastric cancer

Background The results of sentinel node (SN) biopsy have been improved by the use of dye and isotope double tracers in melanoma and breast cancer. However, the usefulness of this double tracer technique has not been determined in gastric cancer. The aim of this study was to investigate the possibility of improving SN biopsy results by using double tracers in gastric cancer.Methods Sixty-four gastric adenocarcinoma patients preoperatively diagnosed as cT1N0, were enrolled in the study. ^99mTc tin colloid was injected by preoperative endoscopy, and lymphoscintigraphy was performed prior to operation. After laparotomy, isosulfan blue was intraoperatively injected using an endoscope. Blue-stained or radioactive nodes were identified and defined as SNs. Gastrectomy with D2 lymphadenectomy was performed in all patients. All dissected lymph nodes were evaluated for metastasis by hematoxylin and eosin staining and immunohistochemistry.Results SN detection rates using dye, isotope, or both tracers were 95.3%, 84.4%, and 96.9%, respectively, and their corresponding sensitivities were 52.9%, 52.9%, and 70.6%. In the pT1 subset, the sensitivity of the double tracer was 87.5%; and in a subset of tumors with diameter <4.5 cm, this was also 87.5%.Conclusions These findings confirm that SN biopsy results are improved by using double tracers in gastric cancer and suggest that SN biopsy is suitable in cases of small-sized early gastric cancer.     

腹腔镜下前哨淋巴结检测在早期宫颈癌中的应用

目的探讨早期宫颈癌腹腔镜下前哨淋巴结（Sentinel lymph node,SLN）检测的可行性及前哨淋巴结活检预测盆腔淋巴结转移状况的准确性,评价SLN活检在早期宫颈癌中的应用价值。方法选择诊断明确的早期宫颈癌患者26例,采用腹腔镜下广泛子宫切除术和盆腔淋巴结清扫术,术中从宫颈分4点注射1%亚甲蓝染料4ml行淋巴绘图,腹腔镜下识别和取蓝染淋巴结活检。蓝染淋巴结和手术的其他标本分别送病理检查,常规石蜡包埋切片、HE染色,以手术后所有切除的盆腔淋巴结常规HE染色病理检查结果为诊断金标准,观察SLN活检对预测盆腔淋巴结有无肿瘤转移的准确性、假阴性率等及SLN分布情况。结果26例宫颈癌中,23例成功检测出SLN,检出率为88.5%（23/26）。共检出SLN51枚,其中1个SLN者6例,2个SLN者9例,3个SLN者6例,4个SLN者1例,5个SLN者1例。双侧分布者占65.2%（15/23）。26例中,5例（19.2%）盆腔淋巴结有转移。23例SLN成功识别的患者中,3例（6枚）SLN存在转移。SLN转移且盆腔淋巴结有转移者2例,SLN是盆腔淋巴结唯一转移者1例,SLN无转移而盆腔淋巴结有转移者1例。SLN活检预测盆腔淋巴结的准确性为95.7%（22/23）,灵敏度为75%（3/4）,特异度为100%（19/19）,阴性预测值为95%（19/20）,SLN与盆腔淋巴结的转移有极好的一致性（κ=0.832）。结论采用腹腔镜技术可以较准确地检测出SLN,可以用于早期宫颈癌SLN活检;SLN能较准确地反映区域淋巴结的转移状况。     

Sentinel lymph node identification for patients with breast cancer using large-size radiotracer particles: technetium-99m-labeled tin colloids produced excellent results

Sentinel lymph node (SLN) biopsies using radioactive tracers have been reported to detect the metastatic status of the axillary lymph nodes in breast cancer patients. However, the optimal radioactive tracer particle sizes remain to be determined. In this study, identification of SLNs with large radiolabeled tin colloid particles was evaluated. Seventy-five patients with T1-2, N0 breast cancer were enrolled. Two hours prior to surgery, 1 to 2.5 mL technetium-99m–labeled tin colloid particles were injected around the tumor under ultrasonographic guidance. Immediately before the operation, dye fluids were also injected around the tumor to increase the interstitial pressure. After axillary dissection, lymph nodes with ×100 or more uptake of radioactivity than the mean of the other lymph nodes are considered to be SLN. All lymph nodes from the axillary dissections were pathologically investigated, and the characteristics of SLNs were evaluated. SLNs were clearly identified in 74 of 75 patients (98.7%). Of 37 patients without SLN metastasis, pathological investigation revealed no further involvement of the remaining non-SLNs. The SLNs tended to be larger in size, and more than 50% were located in the lower medial site of the axilla. This is the first study to show that SLNs could successfully be identified with radiolabeled tin colloid particles. When SLNs were negative for metastases, non-SLNs were always negative.     

Sentinel lymph node biopsy using indigo carmine blue dye and the validity of '10% rule' and '4 nodes rule'

This is the study which assessed sentinel lymph node biopsy (SNB) using indigo carmine blue dye and the validity of the '10% rule' and '4 nodes rule'. Patients (302) were performed SNB using the combined radioisotope (RI)/indigo carmine dye method. Excised SLNs were confirmed whether they were stained and numbered in order of RI count and the percentage of radioactivity as compared to the hottest node was calculated. The relationship between histological diagnosis, dyeing and RI count was assessed. All the patients were detected SLN. Positive nodes were identified in 84 (27.8%) patients and were identified up to the third degree of hottest. All the hottest positive nodes were stained by indigo carmine. From the results, removing the three most radioactive SLNs identified all cases of nodal metastasis without complications. These stopping rules were valid and useful under indigo carmine use too.     

新型前哨淋巴结活检技术在选择性腋窝淋巴结清扫中的应用

目的 采用经前哨淋巴通道(SLC)行前哨淋巴结活检(SLNB)新技术,判断腋窝淋巴结状态及指导选择性腋窝淋巴结清扫(ALND).方法 采用非随机对照研究,通过前哨淋巴通道行SLNB.根据前哨淋巴结(SLN)的术中病理结果行选择性ALND的患者为A组,其中SLN为阳性,行ALND为A1组,SLN为阴性,仅行SLNB为A2组;无论SLN状态,SLNB后均行ALND的患者为B组.结果 2008年7月至2009年6月共114例早期乳腺癌患者行SLNB,检出i12例,A1组28例,A2组25例,B组59例.联合法和染料法检出率为分别为98.1%(102/104)和100.0%(10/10),两者差异无统计学意义(P>0.05).假阴性率为2.30%(2/87),假阳性率为0.89%(1/112).检出SLN1～4枚,共146枚,平均1.3枚.ALND组(A1+B)并发症发生率(52.9%)高于SLNB组(A2)并发症发生率(4.0%)(x~2=15.9675,P相似文献   

Sentinel lymph node biopsy in breast cancer: an analysis of the maximum number of nodes requiring excision

Sentinel lymph node biopsy (SNB) is now the standard of care in assessment of patients with clinically staged T1-2, N0 breast cancers. This study investigates whether there is a maximum number of sentinel lymph nodes (SLN) that need to be excised without compromising the false-negative (FN) rate of this procedure. Data were prospectively collected for 319 patients undergoing SNB between February 2001 and December 2006 at our institution. This data were analysed, both in terms of the order of SLN retrieval and relative isotope counts of the SLNs, in order to determine the maximum number of SLNs that need to be retrieved without increasing the FN rate. Furthermore, we investigated the relationship between SLN blue dye concentration and the presence of SLN metastases. The SLN identification rate was 97% with no false-negative cases amongst patients undergoing simultaneous axillary clearance historically during technique validation. In patients with SLN metastases, excision of the first 4 SLNs encountered results in the identification of a metastatic SLN in all cases. Although the majority (86%) of SNB metastases are in the hottest node, the SLN containing the metastasis is in the first 4 hottest nodes in 99% of patients with nodal metastases. The remaining 1% of SLN metastases were identified by blue dye. There was no statistically significant association between the SLN blue dye concentration and the presence of SLN metastases. A policy to remove a maximum of four blue and/or hot SLNs along with any palpably abnormal lymph nodes does not result in an increased false-negative rate of detection of SLN metastases.     

Axillary sentinel lymph node identification using superparamagnetic iron oxide versus radioisotope in early stage breast cancer: The UK SentiMag trial (SMART study)

Background & ObjectivesSentinel lymph node biopsy (SLNB) is an accurate and reliable method for staging the axilla in early breast cancer. The gold standard technique for localizing the sentinel lymph node (SLN) is the use of radioisotope with or without blue dye. However, this technique has its limitations. Various alternatives have been explored to overcome the disadvantages of the standard SLNB technique and superparamagnetic iron oxide mapping agents have garnered significant attention. The SMART study aims to compare the magnetic technique using the superparamagnetic iron oxide particles (SPIO, Sienna+®) to the radioisotope technique (Tc99) +/− blue dye, for SLN identification in patients with early breast cancer.MethodsA prospective, multicenter study was done that recruited 109 clinically node-negative early-stage breast cancer patients from five centres in the United Kingdom (UK). The patients received radioisotope ± blue dye injections, followed by intraoperative injection of magnetic tracer prior to SLNB. The sentinel node identification rate was compared between the magnetic and standard techniques to evaluate detection rate (per patient and per node), non-inferiority and concordance.ResultsData was analysed for 107 patients. The per patient detection rate was 98.13% (105/107) when using the magnetic tracer and 92.26% (103/107) when using the standard technique. The nodal detection rate was 93.07% (188/202 nodes) when using the magnetic tracer and 96.53% (195/202) when using the standard technique. Of the 31 patients with positive sentinel lymph nodes (SLNs), all 31 (100%) were detected by both techniques.ConclusionOur study demonstrates that the magnetic technique is a feasible method for SLNB, with an identification rate that is not inferior to the standard technique. The magnetic technique offers a suitable alternative to the standard technique thereby avoiding the need for the complexities of nuclear medicine, the hazards of radiation and the anaphylaxis risk of blue dye.     

不同示踪法在胃癌前哨淋巴结检测中的应用比较

目的 探讨理想的胃癌前哨淋巴结(SLN)检测方法.方法 前瞻性分析2004年1月至2008年8月广州军区广州总医院确诊的59例胃癌患者的临床资料,按随机数字表法将患者分为染料法组(20例)、核素法组(20例)和联合法组(19例),分别或联合注射专利蓝和99Tcm进行SLN检测.采用t检验和x2检验分析SLM的检出情况及SLN判断胃癌区域淋巴结转移的准确率和假阴性率.结果 染料法组共检出SLN 38枚,平均1.9枚/例;核素法组共检出SLN 31枚,平均1.6枚/例;联合法组共检出SLN56枚,平均2.9枚/例.联合法组中同时被染料和核素标记的SLN为46枚,单独被染料和核素标记的SLN分别为6枚和4枚.3组SLN检测数目比较,差异有统计学意义(t=4.35,P<0.05).其中联合法组SLN的检出数目明显多于染料法组和核素法组(t=4.21,3.54,P<0.05).染料法组、核素法组和联合法组诊断胃癌淋巴结转移的准确率和假阴性率分别为95%(19/20)和5%(1/20)、90%(18/20)和10%(2/20)、100%(19/19)和0,其中联合法组的准确率最高(x2=163.01,P<0.05),假阴性率最低(x2=170.14,P<0.05).结论 联合染料和核素标记物示踪法是检测胃癌SLN的理想方法.     

Concordance and validation study of sentinel lymph node biopsy for breast cancer using subareolar injection of blue dye and technetium 99m sulfur colloid

BACKGROUND: We have previously demonstrated the utility, accuracy, and advantages of a subareolar (SA) site of injection for blue dye compared with an intraparenchymal site. In later studies we advocated the additional use of preoperative SA-injected technetium 99m-labeled sulfur colloid as a directional aid in finding blue-stained sentinel lymph nodes (SLNs). Paramount to the usefulness of this dual-tracer, same-site technique is the degree to which SA-injected blue dye and SA-injected radiocolloid migrate concordantly and are deposited within the same sentinel nodes. The purpose of this study was to document the correlation and accuracy of SLN biopsy using blue dye and radiocolloid when both nodal markers are injected by the same SA route. STUDY DESIGN: Between September 1999 and February 2002 (29 months), 185 consecutive patients with 187 operable breast cancers underwent 187 attempted SLN biopsies by a dual-tracer, same-site injection technique using the SA approach for both agents. Unfiltered technetium 99m-labeled sulfur colloid (1 mCi [37 MBq]) was SA-injected 30 to 45 minutes preoperatively; and just after anesthetic induction, 3 mL of 1% isosulfan blue dye was injected by the same SA route. SLN biopsies or complete axillary dissections were carried out, and SLNs identified during these procedures were classified as containing both blue dye and radioactivity ("blue-hot" nodes), radioactivity alone ("hot-only" nodes), or blue dye alone ("blue-only" nodes). Cases were categorized and tabulated based on the presence or absence of these three types of SLNs. RESULTS: Of the 187 procedures, a SLN was identified successfully in 184 cases, indicating an SLN identification rate of 98.4% (95% confidence interval, 96.6% to 100.2%). In these 184 cases, a blue-hot node was present in 94.5% (n = 174 of 184). An SLN was positive in 50 cases, or 27.2% of the total group (n = 50 of 184). A blue-hot node was the only positive SLN in 43 of these 50 cases, or 86% of the node-positive cases. There were no false negatives in 20 confirmatory axillary node dissections carried out to document the findings of a negative SLN. A correlation analysis revealed that in 98.9% of cases (174 of 176), blue nodes were also radioactive ("blue-hot" case concordance = 98.9%). In 95.1% of cases (174 of 183), hot nodes had also taken up blue dye ("hot-blue" case concordance = 95.1%). CONCLUSIONS: Using SA injections of both blue dye and radiocolloid, we achieved an SLN identification rate of 98.4% (184 of 187 cases), a false-negative rate of 0% (0 of 20 cases), and an accuracy in predicting the malignant status of the axilla of 100% (70 of 70 cases). The case concordance rate ranged between 98.9% ("blue-hot concordance") and 95.1% ("hot-blue concordance"). The present study is the first to evaluate dual-tracer, same-site SA injections of blue dye and radiocolloid. By demonstrating a high case concordance rate, a high SLN identification rate, and a 0% false-negative rate, this study adds further support to the validity and accuracy of same-site SA injections of both blue dye and radiocolloid during SLN biopsy in breast cancer.     

吲哚菁绿荧光导航技术在乳腺癌前哨淋巴结活检中的应用

目的:评价吲哚菁绿(ICG)荧光技术应用于乳腺癌前哨淋巴结活检(SLNB)的可行性。方法:选择2010年11月—2012年2月期间68例乳腺癌患者,其中36例以ICG荧光导航技术进行SLNB(ICG组),32例应用美蓝为示踪剂行SLNB(染料组)。所有患者SLNB结束后行I、II水平腋窝淋巴清扫。结果:两组基本临床资料差异无统计学意义(均P0.05),具有可比性。ICG组前哨淋巴结(SLN)检出率为97.2%(35/36),染料组为81.3%(26/32),前者明显高于后者(P0.05)。假阴性率与每例患者平均检测SLN数量两组间差异无统计学意义(均P0.05)。结论:用ICG荧光导航技术行乳腺癌SLNB,其检出率高于染料法,且同时具备核素、染料示踪剂的替代选择。     

Ex vivo sentinel lymph node mapping in colon cancer: improving the accuracy of pathologic staging?

BACKGROUND: A subset of patients with colon cancer staged by conventional methods have occult micrometastases and do not receive adjuvant chemotherapy. Sentinel lymph node (SLN) mapping and staining by immunohistochemistry is a technique that may identify such occult micrometastases, thereby upstaging patients with positive findings. The purpose of this study was to determine whether ex vivo SLN mapping in colon cancer could be applied successfully to patients at our institution. METHODS: Seventeen patients with intraperitoneal colon tumors undergoing resection were studied prospectively. SLNs were identified as the first blue stained node(s) after ex vivo peritumoral injection of isosulfan blue dye. Additional lymph nodes were harvested and processed in accordance with standard pathologic evaluation for colon cancer. All nodes were examined after routine hematoxylin and eosin (H&E) staining. SLNs that were negative on H&E were analyzed further by multilevel sectioning and immunohistochemistry staining using anticytokeratin monoclonal antibody. RESULTS: Of the 17 study patients, SLNs were identified in 16 (94%) cases. The SLN was the only positive node in 3 patients. An identified SLN was positive (by H&E) in all patients with associated positive non-SLN nodes. The average number of nodes retrieved per patient was 16 (range, 4-54). Overall, SLNs accurately reflected the status of the entire lymph node basin in 16 (94%) patients. Two (12%) patients with negative nodes by H&E potentially were upstaged after further SLN analysis. The negative predictive value for SLN mapping was 89%. CONCLUSIONS: The ex vivo technique of SLN mapping for colon cancer is feasible. In the current study, SLN results were concordant with non-SLNs in the majority of patients. Furthermore, this technique may have upstaged 2 (12%) patients. Whether this ultimately will affect overall survival has yet to be determined.     

前哨淋巴结活检在结直肠癌根治术中的应用研究

目的探讨前哨淋巴结活检（SLNB）在结直肠癌根治术中临床应用的可行性及其价值。方法应用美蓝对67例结直肠癌患者行前哨淋巴结（SLN）定位活检,分体内、体外组,采用HE染色病理检查法、CK-20免疫组化染色（SP法）检测SLN中转移癌。结果共检出淋巴结660枚,其中SLN130枚,检出率19．7％。腹腔镜结直肠癌根治术和开腹结直肠癌根治术对SLN的检出差异无统计学意义（P=0．742）;体内、体外两种SLN的标记方法差异无统计学意义（P=0．564）;SP法检测SLN癌转移的敏感性明显高于HE染色,而假阴性率明显低于后者;肿瘤细胞在SLN的转移率明显高于区域淋巴结的转移率（P〈0．01）。结论结直肠癌根治术中体内、体外SLN定位方法均可以获得成功,均具有切实的可行性,与手术方式无关,并能够预测区域淋巴结的转移状况;通过SP法检查有助于明确结直肠癌的病理分期,有利于判断预后和个体化治疗方案的制定。