前哨淋巴结检测对预测非小细胞肺癌淋巴结转移的价值

背景与目的:区域淋巴结的转移状态是影响非小细胞肺癌(non-smallcelllungcancer,NSCLC)预后的重要因素之一。前哨淋巴结(sentinellymphnode,SLN)检测技术提供了一种术中快速高效检测淋巴结微转移的手段,但目前SLN技术应用于NSCLC尚不成熟。本实验旨在探索NSCLC根治术中SLN检测的可行性,评价SLN预测区域淋巴结转移状态的准确性。方法:应用染料法对50例NSCLC患者在根治术中于肺肿瘤边缘分4点(3、6、9、12点处)注入异硫蓝溶液4ml,进行SLN活检识别。结果:50例NSCLC患者中共有33例找到蓝染前哨淋巴结,检出率为66.0%。SLN发生于N1淋巴结24例(72.7%)、N2淋巴结6例(18.2%)、同时发生于N1和N2淋巴结3例(9.1%)。SLN识别的灵敏度为73.3%、假阴性率为26.7%、准确率为87.9%。结论:SLN对非小细胞肺癌肺门纵隔淋巴结转移具有预测性。

Predictive value of detection of sentinel lymph nodes on lymphatic metastasis of non-small cell lung cancer

BACKGROUND & OBJECTIVE: The metastasis status of regional lymph node is an important prognostic factor of non-small cell lung cancer (NSCLC). Sentinel lymph node (SLN) mapping and biopsy is a quick and high efficient technique to intraoperatively detect occult micrometastatic disease, however, its application in NSCLC is immature. This study was designed to investigate the feasibility of detecting SLN in patients with NSCLC during radical surgery, and to evaluate its accuracy of predicting metastasis status of regional lymph node. METHODS: Fifty patients with NSCLC underwent SLN detection. During radical operation, 4 ml of 1% isosulfan blue was injected into the lung tissue around the tumor at 3, 6, 9, and 12 o'clock sites. Location and number of blue dyed SLNs were recorded, and compared with pathologic results to calculate the accuracy and false negative rate of SLN detection. RESULTS: Blue dyed SLNs were seen in 33 patients with a detection rate of 66.0%. SLNs located in N1 lymph node of 24 patients (72.7%), in N2 lymph node of 6 patients (18.2%), in both N1 and N2 lymph nodes of 3 patients (9.1%). Approved by pathology, the accuracy of SLN detection was 87.9% (29/33), the sensibility was 73.3% (11/15), the false negative rate was 26.7% (4/15). CONCLUSION: SLN detection is valuable for predicting hilar and mediastinal lymph nodes metastases in NSCLC.