前哨淋巴结显像在口腔鳞癌分期诊断中的价值

目的 评价前哨淋巴结(SLN)显像等指导活组织检查技术(SLNB)在口腔鳞癌分期诊断中的作用.方法 Cn0期口腔癌患者31例,肿瘤旁黏膜下注射专利蓝和99Tcm-右旋糖酐(DX),分别采用蓝染法、淋巴显像法、术中γ探测法定位SLN.行常规病理检查,同时对常规切片阴性者采用连续切片,分别进行HE染色和鼠抗人角蛋白抗体(Ael/AE3)免疫组织化学检测.计算SLN的检出率及评价cNo期口腔鳞癌颈部淋巴结真实状态.结果 用蓝染法、γ探测、淋巴显像分别检测出25(80.6%),31(100.0%),30(96.8%)例的SLN,SLN分别为44,55,51枚,平均每例1.4(1～3)枚.非 SLN(NSLN)1302枚.常规病理检查SLN转移(阳性)6枚(6例),其中1例伴NSLN转移.连续切片+常规HE染色检出I例SLN转移.续切片+AE1/AE3免疫组织化学染色检出2例SLN转移.未发现单独的NSLN转移病例.结论 蓝染法、γ探测和淋巴显像对SLN均具有较高的检出率,其指导的SLNB检测可显示cN0期口腔鳞癌颈部淋巴结的真实状态;连续病理切片和AE1/AE3免疫组织化学检测有助于微小转移灶的检出.

The value of sentinel lymph node biopsy in staging of cN0 oral squamous cell carcinoma

Objective Sentinel lymph node(SLN)detection in head and neck cancer with cN0 is important.The purpose of this study was to assess the potential role of SLN in staging oral squamous cell carcinoma(OSCC)with cN0.Methods Thirty-one OSCC patients with cN0 were included.All patients had preoperative lymphoscintigraphy,intraoperative blue dye and γ-ray probe and neck dissections.Routine pathology and serial sectioning of SLN and cytokeratin immunohistochemical (IHC)staining were performed to evaluate the nodal status.ResultS The results showed that the sensitivity of nodal identification was highest in γ-ray probe100.0%(31/31)],followed by lymphoscintigraphy96.8%(30/31)]and blue dye 80.6%(25/31)].In all,eight patients with nodes had metastases.Six SLN in six patients were identifled by routine examination with HE staining.SLN in two patients were identified from series section and staining with HE and cytokeratin.Of the 31 OSCC patients with cNn,no single NSLN was found to have metastasis,if the SLN was negative.Conclusions γ-ray probe and lymphoscintigraphy has high sensitivity in detecting SLN on OSCC patients with cN0.Series section and staining with HE and cvtokeratin can improve the sensitivity and accuracy of the initial staging in OSCC patients with cN0.