Catarci M, Zaraca F, Angeloni R, Mancini B, de Filippo M G, Massa R, Carboni M, Pasquini G
Department of Surgery, Hospital of Velletri, University of Rome "La Sapienza" Medical School, Rome, Italy.
J Surg Oncol. 2001 May;77(1):21-4; discussion 25. doi: 10.1002/jso.1058.
Lymphadenectomy for papillary thyroid cancer is a matter of debate. After showing its usefulness as a prognostic factor in both melanoma and breast cancer, the concept of sentinel lymph node biopsy was also recently applied to differentiated thyroid cancer. To date, all attempts to locate and remove the sentinel node were based on the intraoperative injection of a vital dye. The feasibility and the technical details of using preoperative lymphoscintigraphy coupled with intraoperative vital dye and gamma probe scanning were investigated and discussed.
Six patients diagnosed with papillary thyroid cancer were submitted to preoperative lymphoscintigraphy with (99m)Tc-labelled colloidal albumin at different dosages. The operation consisted in a total thyroidectomy with sentinel lymph node biopsy guided by intraoperative injection of a vital dye (Blu Patent V, 2.5%) and scanning with a hand-held gamma probe. Lymph node dissection was completed in the area in which the sentinel node was located.
The sentinel node was identified using all the three methods in all cases (100%). Considering one of the methods alone, identification rates were 66, 50, and 83% for preoperative lymphoscintigraphy, vital dye, and probe scanning, respectively. One sentinel node was identified in four cases and two in the other two cases. The optimal dosage of the tracer appeared to be at 22 MBq.
These results underline the necessity to use the combination of nuclear medicine imaging and lymphatic vital dye in order to enhance the identification rate of sentinel node also in thyroid cancer. It is now necessary to check the diagnostic accuracy of this procedure through a controlled trial involving a more extended lymph node dissection in the neck.
甲状腺乳头状癌的淋巴结清扫术存在争议。在前哨淋巴结活检的概念被证明在黑色素瘤和乳腺癌中作为预后因素有用后，最近也被应用于分化型甲状腺癌。迄今为止，所有定位和切除前哨淋巴结的尝试均基于术中注射活性染料。本研究对术前淋巴闪烁显像联合术中活性染料及γ探针扫描的可行性和技术细节进行了探讨。
6例诊断为甲状腺乳头状癌的患者接受了不同剂量的（99m）Tc标记胶体白蛋白术前淋巴闪烁显像。手术包括全甲状腺切除术，术中注射活性染料（专利蓝V，2.5%）并使用手持式γ探针扫描以引导前哨淋巴结活检。在前哨淋巴结所在区域完成淋巴结清扫。
所有病例（100%）均使用三种方法识别出了前哨淋巴结。单独考虑其中一种方法时，术前淋巴闪烁显像、活性染料及探针扫描的识别率分别为66%、50%和83%。4例患者识别出1个前哨淋巴结，另外2例患者识别出2个前哨淋巴结。示踪剂的最佳剂量似乎为22MBq。
这些结果强调了联合使用核医学成像和淋巴活性染料以提高甲状腺癌前哨淋巴结识别率的必要性。现在有必要通过一项涉及更广泛颈部淋巴结清扫的对照试验来检验该方法的诊断准确性。
