Lucci A, Turner R R, Morton D L
Roy E. Coats Research Laboratories, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA 90404, USA.
Surgery. 1999 Jul;126(1):48-53. doi: 10.1067/msy.1999.99055.
The success of intraoperative lymphatic mapping depends on accurate identification of the sentinel node. We hypothesized that a carbon particle suspension would allow histopathologic confirmation of the sentinel lymph node through deposition of carbon within that node.
An animal model was used to compare the lymphatic mapping accuracy of carbon dye with that of isosulfan blue dye, the standard agent for intraoperative visualization of the sentinel lymph node. Twenty-two rats underwent lymphatic mapping in each distal lower extremity with various combinations of carbon dye and isosulfan blue dye. All stained (blue or black) nodes in the inguinal drainage basin were removed for pathologic analysis, including carbon particle analysis. A meticulous search identified all nonstained (nonsentinel) nodes in the same basin. These nonsentinel nodes were examined for carbon particles by light microscopy. Dermal diffusion of mapping agents at the injection site was also recorded. Animals were then observed for 28 days to assess the toxicity of mapping agents.
Although isosulfan blue dye and full-strength carbon dye each stained all sentinel nodes, the latter obscured histologic detail. The combination of 2.5% carbon dye, 7.5% saline solution, and 90% isosulfan blue dye also stained all sentinel nodes; carbon particles were seen on light microscopy in all 13 stained nodes and did not interfere with histologic evaluation. No unstained node contained carbon particles, although the number of nonsentinel nodes was small. Carbon dye exhibited significantly less intradermal diffusion than isosulfan blue dye, but the carbon left a permanent mark on the skin. No toxicity or side effect associated with the use of carbon dye was observed.
Carbon dye allows histopathologic confirmation of sentinel lymph nodes identified by isosulfan blue dye.
术中淋巴绘图的成功取决于前哨淋巴结的准确识别。我们推测碳颗粒悬液可通过碳在该淋巴结内的沉积实现前哨淋巴结的组织病理学确认。
使用动物模型比较碳染料与异硫蓝染料（术中前哨淋巴结可视化的标准试剂）的淋巴绘图准确性。22只大鼠在每个下肢远端用碳染料和异硫蓝染料的不同组合进行淋巴绘图。腹股沟引流区域内所有染色（蓝色或黑色）的淋巴结均被切除进行病理分析，包括碳颗粒分析。仔细搜索确定同一区域内所有未染色（非前哨）的淋巴结。通过光学显微镜检查这些非前哨淋巴结是否有碳颗粒。还记录了绘图剂在注射部位的真皮扩散情况。然后观察动物28天以评估绘图剂的毒性。
尽管异硫蓝染料和原液碳染料均能使所有前哨淋巴结染色，但后者会掩盖组织学细节。2.5%碳染料、7.5%盐溶液和90%异硫蓝染料的组合也能使所有前哨淋巴结染色；在所有13个染色淋巴结的光学显微镜下均可见碳颗粒，且不影响组织学评估。尽管非前哨淋巴结数量较少，但未染色的淋巴结中均未发现碳颗粒。碳染料的真皮扩散明显少于异硫蓝染料，但碳会在皮肤上留下永久性痕迹。未观察到与使用碳染料相关的毒性或副作用。
碳染料可对异硫蓝染料识别出的前哨淋巴结进行组织病理学确认。
