头颈部癌前哨淋巴结的临床研究

目的 探讨头颈部肿瘤前哨淋巴结的检测及其对淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法，对51例未经治疗的头颈部癌颈淋巴结NO的患者进行了手术中前哨淋巴结的临床研究。手术中取前哨淋巴结作快速冰冻病理，并与手术后常规石蜡切片病理对照，观察冰冻病理前哨淋巴结转移和常规病理颈淋巴结转移的相关性及其对颈淋巴结转移 癌的预测值。结果 51例中48例成功的显示了前哨淋巴结，成功率94．1％，前哨淋巴结平均每例每侧2．5枚。11例前哨啉巴结阳性，其中2例有前哨淋巴结以外的颈淋巴结转移，2例为假阴性。前哨淋巴结对颈淋巴结转移的总阳性预测值为85％。结论 前哨淋巴结检测对头颈部癌的淋巴结转移有重要的预测价值。

Sentinel lymph node biopsy in head and neck cancer patients

OBJECTIVE: By performing sentinel lymph node (SLN) biopsy, its detecting and predictive value to the cervical metastasis in the head and neck cancer patients was studied. METHODS: Intraoperative SLN biopsy was done in 51 untreated head and neck cancer patients who all had no metastasis before operation. The lesions were: laryngeal cancer 23, pharyngeal cancer 6, thyroid cancer 20 and cancer of the tongue 2. Fifteen minutes before taking the SLN, local 0.2 to 0.5 ml 2% isosulfan blue dye was submucously injected 0.5 cm away from the upper, lower, right and left margin of the primary tumor. The frozen sections of SLN were compared with the routine pathological sections of the cervical lymph nodes. The metastatic relation between the SLN and the cervical nodes as well as SLN's predictive value to the cervical nodes metastasis were analyzed. RESULTS: SLN was successfully revealed in 48 (94%) of these 51 patients, averaging 2.5 nodes per patient. They were: laryngeal cancer 22, pharyngeal cancer 6, thyroid cancer 18 and lingual cancer 1. Eleven of these SLNs were positive, among whom two had lymph node metastasis in addition to the SLN. Two others were false negative. The positive predictive value of SLNs to the cervical lymph node metastasis was 85%. CONCLUSION: The predictive value of sentinel lymph node to the cervical metastasis is important in head and neck cancer patients.