Tsugawa K, Ohnishi I, Nakamura M, Miwa K, Yokoyama K, Michigishi T, Noguchi M, Nonomura A
Department of Surgical Oncology (Surgery II), Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa-city, Ishikawa 920-8641, Japan.
Biomed Pharmacother. 2002;56 Suppl 1:100s-103s. doi: 10.1016/s0753-3322(02)00276-7.
We examined the feasibility of sentinel lymph node biopsy for thyroid cancer. Thirty-eight patients with papillary thyroid carcinoma underwent intraoperative lymphatic mapping and sentinel lymph node biopsy. At surgery, we exposed the thyroid gland and used a tuberculin syringe to inject 0.2 ml of 1% patent blue dye directly into the thyroid mass. The lymphatics and the lymph node dyed with blue dyes, was excised as a sentinel lymph node. Modified radical neck dissection was performed following sentinel lymph node biopsy and the diagnostic ability of sentinel lymph node biopsy was examined. A sentinel lymph node was identified successfully in 27 (71%) of 38 patients. Sentinel lymph node biopsy removed one to three lymph nodes (median, two nodes). Eighteen patients had paratracheal sentinel lymph nodes, five patients had jugular sentinel lymph nodes, and four patients had both. Histological nodal metastasis was recognized in 16 of 27 cases. The positive rate of cancer metastases in sentinel lymph nodes was 58%, which was significantly higher than 11% in non-sentinel lymph nodes. Diagnostic ability of sentinel lymph node biopsy showed that accuracy was 89%, sensitivity was 84%, and specificity was 100%. Our preliminary study indicated that sentinel lymph node biopsy was available on detection of non-palpable nodal metastasis in the patients with thyroid cancer; however, further experience and refinement are needed.
我们研究了前哨淋巴结活检用于甲状腺癌的可行性。38例甲状腺乳头状癌患者接受了术中淋巴绘图和前哨淋巴结活检。手术时，我们暴露甲状腺，并用结核菌素注射器将0.2毫升1%的专利蓝染料直接注入甲状腺肿块。将被蓝色染料染色的淋巴管和淋巴结作为前哨淋巴结切除。在前哨淋巴结活检后进行改良根治性颈清扫，并检查前哨淋巴结活检的诊断能力。38例患者中有27例（71%）成功识别出前哨淋巴结。前哨淋巴结活检切除1至3个淋巴结（中位数为2个淋巴结）。18例患者有气管旁前哨淋巴结，5例患者有颈静脉前哨淋巴结，4例患者两者均有。27例中有16例出现组织学淋巴结转移。前哨淋巴结中癌转移的阳性率为58%，显著高于非前哨淋巴结中的11%。前哨淋巴结活检的诊断能力显示，准确率为89%，敏感性为84%，特异性为100%。我们的初步研究表明，前哨淋巴结活检可用于检测甲状腺癌患者不可触及的淋巴结转移；然而，还需要进一步的经验和改进。
