前哨淋巴结核素-染料联合检测术在早期宫颈癌中的应用

目的探讨用前哨淋巴结（SLN）核素-染料联合检测术检出早期宫颈癌的可行性及其应用价值。方法选择2005年3月-2006年4月本院收治的50例按国际妇产科学联盟（FIGO，1994年）标准诊断为Ⅰb-Ⅱa期宫颈癌患者，于肿瘤旁3点钟和9点钟位置各对称注射^99Tc^m-硫胶体148 MBq（4×10^-4L）后15～60min行SLN显像；术中用1探测器探测“热点”淋巴结，并于瘤旁3点钟和9点钟位置注射亚甲蓝2～4ml，记录蓝染淋巴结和“热点”淋巴结数目和部位，再行广泛子宫切除和盆腔淋巴结清扫术及淋巴结病理检查，分析SLN检出率、病理检查结果及与非SLN（NSLN）的关系等。采用SPSS 13.0软件进行统计学处理。结果50例患者核素-染料联合法SLN检出率96．0％（48／50），核素法SLN检出率92．0％（46／50），染料法检出率70．0％（35／50），后两者差异有统计学意义（χ^2=4．92，P〈0．05）。核素法中有37例显像结果与术中γ探测结果一致，符合率为74．0％（37／50）。48例核素-染料联合法检出SLN的患者中，有11例（22．9％）SLN病理检查常规HE染色显示转移，余37例中有1例SLN未显示转移而NSLN显示转移。2例未检出SLN患者中，有1例出现NSLN转移，联合法对SLN探测准确性为97．9％（47／48），假阴性1例，阴性预测值为97．3％（36／37）。共159枚SLN中，分布于闭孔淋巴结115枚（72．3％），髂内淋巴结8枚（5．0％），髂外淋巴结19枚（12．0％），髂总淋巴结11枚（6．9％），宫旁淋巴结6枚（3．8％），左侧SLN总数（90枚）多于右侧（69枚），且差异有统计学意义（χ^2=5．06，P=0．021）。结论核素-染料联合法检测早期宫颈癌SLN是可行的，且其在预测盆腔淋巴结有无转移等方面具有一定的应用价值。

Sentinel lymph node detection in early stage cervical cancer with combined radioisotope and blue dye method

Objective The aim of this study was to investigate the feasibility and clinical value of detecting sentinel lymph node (SLN) with combined radioisotope and blue dye method in early stage cervical cancer. Methods Between March 2005 and April 2006, 50 patients with cervical cancer, who were staged Ⅰ b and Ⅱ a by International Federation of Gynecology and Obstetrics (FIGO), underwent SLN detection with preoperative lymphoscintigraphy. A dose of 148 MBq (4×10-4L) 99Tcm-sulfur colloid (SC) was injected into the uterine cervix at 3 and 9 o'clock position with lymphoscintigraphy taken at 15-60 min after injection. Intraoperative detection of "hot spot" lymph nodes was performed with a handheld gamma probe (γ-detection). During operation, 2-4 ml metend blue dye (BD-detection) was injected into the uterine cervix at the same positions. All patients underwent hysterectomy and pelvic lymphadenectomy. The spatial and pathological relationships of the SLN samples were compared between the two methods. SPSS 13.0 was used for statistical analysis. Results The detection rate of SLN with combined radioisotope and blue dye was 96.0% (48/50). γ-detection alone was 92.0% (46/50) and BD-detection alone was 70.0% (35/50, x2=4.92, P<0.05). In 37 patients lymphoseintigraphy showed the same SLN as γ-detection did, with a coincidence rate of 74.0% (37/50). The SLN with metastases were confirmed by histopathology in 11/48 (22.9%) patients. In the remaining 37 patients with SLN negative for metastasis, there was 1 case with non-SLN showing metastasis. In the 2 patients negative for SLN, 1 was positive for non-SLN metastasis. The SLN accuracy rate was therefore 97.9% (47/48), and the negative predictive value was 97.3% (36/37) with one patient false negative. About 72.3 % (115/159) of SLN were found in obturator region, 5.0% (8/ 159) in iuteriliac region, 12.0% (19/159) in external iliac chain, 6.9% (11/159) in common iliac region and 3.8% (6/159) in parametrium. The number of left-sided SLN detected was more than that of the right (x2=5.06, P=0.021 ). Conclusion Combined radioisotope and blue dye technique is a feasible and valuable tool to detect pelvic SLN in patients with early uterine cervical malignancy.