放射导向手术对非小细胞肺癌胸内转移淋巴结检测的临床价值

目的：采用放射导向手术检测经^99mTc—MIBI标记的非小细胞肺癌病人30例，探讨对非小细胞肺癌胸内转移淋巴结检测的临床价值。方法：用放射导向手术探测肺内和纵隔淋巴结及切除的标本，术后对常规病理为阴性的淋巴结，即假阳性进行连续切片，HE染色，显微镜下观察。然后计算及统计学处理。结果：用放射导向手术探测淋巴结的灵敏度为100％，特异度96．9％，准确率97．42％。结论：放射导向手术比其他检测方法有更高的准确率和更低的漏诊率，能检测出微小的转移淋巴结，指导手术廓清的进行。

Clinical Value of Detection of Intrathoracic Metastatic Lymph Nodes with Radioguided Technique in Patients with Non -small Cell Lung Carcinoma

Objective To study the possible clinical feasibility of intraoperative detection of metastatic lymph node with radiogu- ided technique after labeling with ^99mTc - MIBI in patients with non - small cell lung carcinoma. Methods Gamma - detecting probe was used intra - operatively to examine the radioactivity of lungs, regional and mediastinal nodes in 30 patients with non - small cell lung carcinoma after intravenous injuction of ^99mTc - MIBI （740MBq） 30 minutes before operation for radio - labeling of the nodes. Pestoperatively, the radiologically positive but conventionally pathologically negative as well as all the other nodes judged to be negative with conventional standard （altogether 201 groups） were all meticulously examined with serial sections and immunohistologic staining for detection of the presence of micro - metastasis. Results Altogether 41 groups of nodes specimens were radiologically positive （ over twofolds of normal radio - activity measured with γ Probe）, of which conventional pathological examination revealed metastasis in 32 groups. The remaining 9 groups of specimens were examined further with serial sections and IHC studies and micro - metastasis was found in 3 of them. Thus, the sensitivity of the radioguided technique was 100%, specificity 96.9% and accuracy rate 97.42%. In the remaining 192 radiologically negative groups of lymph nodes studied, no false negative cases （i. e. micrometastasis positive） were demonstrated. Conclusion The radio - guided technique is very sensitive （ 100% ）, highly specific and accurate （98.9%）, and 97.4% respectively）, without false negativity demonstrated. Its practical clinical application seems to be feasible.