用Tc-99m锡胶体检测食管癌和胃癌患者的前哨淋巴结

Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer.

作者信息

Yasuda Seiei, Shimada Hideo, Chino Osamu, Tanaka Hikaru, Kenmochi Takahiro, Takechi Masahiko, Nabeshima Kazuhito, Okamoto Yuichi, Kato Yuko, Kijima Hiroshi, Suzuki Yutaka, Ogoshi Kyoji, Tajima Tomoo, Makuuchi Hiroyasu

机构信息

Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

出版信息

Jpn J Clin Oncol. 2003 Feb;33(2):68-72. doi: 10.1093/jjco/hyg020.

DOI:10.1093/jjco/hyg020

PMID:12629056

Abstract

BACKGROUND

The aim of this study was to determine by radioisotope use whether the sentinel lymph node concept is applicable to esophagogastric cancers. In addition, we examined radioactivities of hot nodes and compared them with the sensitivity of a gamma probe.

METHODS

The subjects were 44 patients, 23 with esophageal cancer and 21 with gastric cancer. The day before surgery, patients underwent endoscopic submucosal injection of 184 MBq of Tc-99m tin colloids into sites surrounding the tumor. Radioisotope activities of lymph nodes dissected at surgery were measured with a well-typed gamma detector and each lymph node was categorized as a hot or cold node. Histopathology of the lymph nodes was examined by hematoxylin and eosin staining. Radioisotope activities and histopathological results were compared to determine whether radioisotope flow reflects lymphatic flow to regional lymph nodes. The sensitivity of a gamma probe was measured in a laboratory study and the relation between the radioisotope activities of hot nodes and the detection sensitivity of the gamma probe was examined.

RESULTS

Histopathological examination revealed lymph node metastasis in 18 of the 44 patients. In 15 of these 18 patients, metastatic foci were recognized in at least one hot node. Subsequent analysis was performed on the 36 patients in whom tumor invasion was confined to the muscle layer and in whom endoscopic clippings had not been applied. Lymph node metastases were observed in 12 of these 36 patients. In these 12 patients, at least one hot node was positive for metastasis. The laboratory study revealed that the gamma probe was able to detect radioisotope activities of >/=0.02 micro Ci. Thirty-two of 63 (51%) esophageal cancer hot nodes and 16 of 86 (19%) gastric cancer hot nodes showed radioisotope activities below the detection sensitivity of the gamma probe.

CONCLUSION

The sentinel lymph node concept is applicable to patients with esophageal and gastric cancers; however, further studies are necessary to identify hot nodes accurately using gamma probes.

摘要

背景

本研究旨在通过放射性同位素的应用来确定前哨淋巴结概念是否适用于食管癌和胃癌。此外，我们检测了热结节的放射性，并将其与γ探测仪的灵敏度进行比较。

方法

研究对象为44例患者，其中23例为食管癌患者，21例为胃癌患者。手术前一天，患者接受内镜下在肿瘤周围部位黏膜下注射184MBq的锝-99m锡胶体。用井型γ探测器测量手术中切除淋巴结的放射性同位素活性，并将每个淋巴结分为热结节或冷结节。通过苏木精和伊红染色检查淋巴结的组织病理学。比较放射性同位素活性和组织病理学结果，以确定放射性同位素流动是否反映区域淋巴结的淋巴流动。在实验室研究中测量γ探测仪的灵敏度，并检测热结节的放射性同位素活性与γ探测仪检测灵敏度之间的关系。

结果

组织病理学检查显示44例患者中有18例发生淋巴结转移。在这18例患者中的15例中，至少在一个热结节中发现了转移灶。随后对36例肿瘤侵犯局限于肌层且未进行内镜活检的患者进行了分析。这36例患者中有12例观察到淋巴结转移。在这12例患者中，至少有一个热结节转移阳性。实验室研究表明，γ探测仪能够检测到放射性同位素活性≥0.02微居里。63个食管癌热结节中的32个（51%）和86个胃癌热结节中的16个（19%）显示放射性同位素活性低于γ探测仪的检测灵敏度。