探测前哨淋巴结在乳腺癌、早期宫颈癌和头颈鳞癌中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌、宫颈癌和头颈鳞癌中确定前哨淋巴结(SLN)的应用价值。方法女性乳腺癌116例,体检腋窝未扪及肿块。应用99Tcm-DX37~74MBq(1~2mCi)经皮下注射,或术中注射专利兰1ml,术中用γ探针定位并行前哨淋巴结活检,与手术、病理对照。宫颈癌27例,体检盆腔未扪及肿块。应用99Tcm-DX74MBq(2mCi)在宫颈肿瘤周围2°或10°处或99Tcm-SC74MBq(2mCi)阴道镜直视下四点注射,行核素淋巴显像后,手术后的标本用γ探针行体外定位,并与病理的结果加以对照。N0头颈鳞癌10例,99Tcm-DX74MBq(2mCi)肿瘤周围成分下注射,术中用γ探针定位并行前哨淋巴结活检,与手术、病理对照。结果116例乳腺癌中活检SLN108例,灵敏度为92.6%(22/27例),特异性100%(81/81例)。27例宫颈癌中SLN的灵敏度为100%(6/6例),特异性100%(21/21例)。10例N0头颈鳞癌中SLN转移3例,NSLN转移1例。结论核素淋巴显像和γ探针定位应用于乳腺癌、宫颈癌和N0头颈鳞癌是切实可行和可能的,这是一种简便、安全、易被病人接受的探测前哨淋巴结的检查方法,对预测腋窝淋巴结、盆腔淋巴结等转移有很大的临床实用价值。

Preliminary application of sentinel lymph node detection in breast cancer, cervical cancer and squamous cell carcinoma of the head and neck

Objective To assess the value and the concept of the sentinel lymph node by lymphoscintigraphy and gamma detector porbe in breast cancer, in early cervical cancer and squamous cell carcinoma of the head and neck (HNSCC). Methods Between Jun, 1999 and Sep, 2005, 116 patients with operable invasive breast cancer and clinically proved negative axillary lymph nodes, 27 patients with early cervical cancer and 10 patients with N_0 squamous cell carcinoma of the head and neck were enrolled in the study. The ~ 99 Tc~m -Dextran of 37-74 MBq (1-2 mCi) or/and patent blue dye were injected subdermally around the primary tumor in breast cancer. The ~ 99 Tc~m -Dextran of 74 MBq (2 mCi) or ~ 99 Tc~m -SC of 74MBq injected the uterine cervix in early cervical cancer. The ~ 99 Tc~m -Dextran of 74 MBq (2 mCi) injected peritumoral submucosal in HNSCC. Lymphoscintigraphy and gamma probe detecting were used to detect the sentinel lymph node (SLN). Results The SLN was identified in 108 of the 116 patients in breast cancer. The sensitivity and the specificity of the SLN detecting to predict the metastasis of the axillary lymph node were 92.6% and 100%, respectively. In cervical cancer with the sensitivity and the specificity of predicting of the pelvic lymph node metastasis by the SLN detection were 100% and 100%, respectively. In HNSCC with three patients revealed occult metastatic disease. Conclusion Lymphoscintigraphy combined by the gamma detector probe for the SLN detecting is well established in breast cancer, HNSCC and cervical cancer. The technique is simple, safe and well accepted by patients.