Akduman B, Fleshner N E, Ehrlich L, Klotz L
Division of Urology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Urology. 2001 Jul;58(1):65-8. doi: 10.1016/s0090-4295(01)01087-1.
To report the initial experience with sentinel node identification using the gamma probe in patients with intermediate-risk penile cancer (T2NXM0, or T1 with intermediate or high-grade disease) and impalpable groin nodes.
Technetium-99m-labeled sulfur colloid was injected at the site of primary penile carcinoma 1 hour before surgery. The sentinel lymph nodes were located using the gamma probe and excised through a 3-cm inguinal incision. A full groin dissection was performed only in cases in which frozen section of the node demonstrated metastasis.
Nine sentinel nodes were identified by the gamma probe and excised in 5 men. In 3 patients, the sentinel nodes were negative bilaterally. In 2 patients, the sentinel node, although grossly normal, showed a single focus of metastasis by frozen section analysis. In both of these patients, a full groin dissection was carried out and revealed no other nodal metastases. All 5 remained free of recurrence (median follow-up 18 months, range 16 to 23).
In patients with microscopic involvement of a single lymph node only (confirmed by full groin dissection), gamma probe identification was 100% accurate. None of the patients with negative sentinel nodes had a recurrence. Biopsy of the sentinel nodes using the gamma probe can predict the presence or absence of inguinal node metastasis in patients with intermediate-risk penile cancer, sparing many patients the long-term morbidity of a full groin dissection. These initial results suggest further study is warranted.
报告在患有中度风险阴茎癌（T2NXM0，或T1期伴中度或高度病变）且腹股沟淋巴结不可触及的患者中，使用γ探测仪识别前哨淋巴结的初步经验。
术前1小时在原发性阴茎癌部位注射99m锝标记的硫化胶体。使用γ探测仪定位前哨淋巴结，并通过3厘米的腹股沟切口将其切除。仅在淋巴结冰冻切片显示转移的情况下才进行全腹股沟淋巴结清扫术。
γ探测仪识别出9个前哨淋巴结并在5名男性患者中进行了切除。3例患者双侧前哨淋巴结均为阴性。2例患者的前哨淋巴结尽管大体正常，但冰冻切片分析显示有单个转移灶。在这2例患者中均进行了全腹股沟淋巴结清扫术，未发现其他淋巴结转移。所有5例患者均无复发（中位随访18个月，范围16至23个月）。
在仅单个淋巴结有微小转移的患者中（经全腹股沟淋巴结清扫术证实），γ探测仪识别的准确率为100%。前哨淋巴结阴性的患者均无复发。使用γ探测仪对前哨淋巴结进行活检可预测中度风险阴茎癌患者腹股沟淋巴结转移的有无，使许多患者免于全腹股沟淋巴结清扫术带来的长期并发症。这些初步结果表明有必要进一步研究。
