舌癌前哨淋巴结活检的临床研究

目的　探索前哨淋巴结 (sentinelnode ,SN)活检能否准确评价舌癌颈淋巴结转移状况及其适应范围。方法　使用术前核素扫描法和术中亚甲蓝示踪法对临床N0 (cN0 )舌癌 2 0例和临床N (cN )舌癌 5例进行SN示踪 ,对比SN和颈清扫标本石蜡切片病理结果。结果　全组 2 5例检出SN 2 4例 ,检出率为 96 % ,共 5 3个 ,平均每例 2 2个 ;cN0 组 2 0例全部检出SN并准确评价颈淋巴结转移状况 ;cN 组 5例中检出SN 4例 ,4例中cN 颈部 5侧 ,其中有 4侧检出SN ,2侧为假阴性 ,cN0颈部 3侧中 2侧检出SN ,均为SN pN 。结论　核素扫描法和生物染料法结合能有效地对舌癌进行SN示踪 ;SN活检能准确地评价cN0 舌癌颈部淋巴结转移状况 ;能否用于评价cN 病例的cN0 侧颈部淋巴结转移状况需进一步研究。

Clinical research of sentinel node biopsy in oral tongue carcinoma

Objective This study was designed to evaluate whether sentinel node (SN) biopsy can accurately assess the cervical lymph node status of oral tongue carcinoma, as well to research the best method and indications of SN biopsy Methods Preoperative lymphoscintigraphy with 99m Tc SC and intraoperative sentinel node mapping with methylene blue dye were administered on 20 cases of oral tongue carcinoma with cN 0 neck and 5 cases with cN neck; routine pathological examination was used to assess the status of SNs The results of routine pathological examination of cervical specimen were set as golden standard to assess the efficacy of SN biopsy in evaluating the cervical lymph node status Results 53 SNs were detected in 24 cases out of the total 25 cases (96%), averaging 2 2 SNs per case SNs were detected in all 20 cases with cN 0 neck, in which 4 cases with occult cervical metastasis were detected by SN diopsy, without false negative case found in the procedure In 5 cases with cN neck, SNs were detected in 4 cases In 4 cases whose SNs were detected, there were 5 cN necks, out of which SNs were detected in 4 cN necks but failed to predicted the cervical lymph node status in 2 necks However, SNs were detected in 2 out of the other 3 cN 0 necks, both of which were diagnosed as SN pN Conclusions Nuclear lymphoscintigraphy and blue dye mapping can be used to trace the SNs in cases with oral tongue carcinoma, with satisfactory detective rate SN biopsy can accurately evaluate the cervical lymph node status in cases of oral tongue carcinoma with cN 0 neck Whether it can be used to evaluate the lymph node status of the cN 0 neck in case with a contralateral cN neck is worthy of further research