前哨淋巴结检测对预测早期子宫颈癌淋巴转移的价值

目的 评价早期宫颈癌前哨淋巴结(SLN)检测的临床价值。方法 选择早期宫颈癌(临床分期Ⅰa-Ⅱa期)患者28例,于术前约18h,分别于宫颈10点及2点处黏膜下注射37MBq(0．4ml)的放射性核素——^99mTc标记的右旋糖酐(^99mTc—DX),即刻行淋巴核素显像。次日行广泛性子宫切除及盆腔淋巴清扫术。手术标本随即行γ探测仪体外探测识别SLN,解剖出SLN后单独送检,病理检查结果与非前哨淋巴结(NSLN)进行比较。结果 28例患者中27例(96％)识别出SLN。手术标本共取得814枚淋巴结,其中123枚为SLN。SLN集中分布于盆腔的髂内、外血管周围及闭孔区。6例(21％)发现盆腔淋巴结转移,共11枚转移淋巴结均为SLN,无假阴性情况出现。结论 SLN对宫颈癌盆腔淋巴结转移具有预测性,临床应用价值尚待进一步探讨。

A pilot study on the detection of sentinel lymph nodes in early stage cervical cancer

OBJECTIVE: The purpose of this study was to investigate the clinical value of sentinel lymph node (SLN) detection in the management of early stage cervix cancer. METHODS: Twenty eight patients with early stage (Ia - IIa) cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in the study. 37 Mbq (0.4 ml) (99m)Tc-labeled dextran ((99m)Tc-DX) was injected to the cervix at two locations (2 and 10 o'clock) 18 hours before the operation followed by preoperative lymphoscintigraphy to detect the SLNs. During the operation, SLNs were identified from dissected LN by gamma-counter. The samples of SLNs and non-SLNs (NSLN) were recorded separately and compared with the final pathology results. RESULTS: SLN was identified in 27 of 28 (96%) patients. A total of 123 SLNs were identified from 814 lymph nodes. Six (21%) patients had altogether 11 positive lymph nodes, which were all SLNs. No patient had false-negative SLNs. CONCLUSIONS: SLNs can successfully predict the lymphatic metastasis in patients with cervical cancer. The clinical validity of this technique should be further evaluated.