Levine Edward A, Shen Perry, Shiver Stephen A, Waters Gregory, Brant Andrew, Geisenger Kim R
Surgical Oncology Service, Wake Forest University, Winston-Salem, North Carolina 27157, USA.
J Gastrointest Surg. 2003 Jul-Aug;7(5):687-91. doi: 10.1016/s1091-255x(03)00069-6.
Although originally described for breast cancer and melanoma, sentinel lymph node (SLN) mapping techniques are being investigated in the treatment of visceral malignancies. There is no literature evaluating intraoperative analysis of SLNs from visceral sites. We evaluated the utility of touch preparation intraoperative imprint cytology (IIC) in evaluating SLNs harvested in the setting of visceral malignancy. SLN mapping procedures involving 50 cases of visceral malignancy (37 colon, 12 gastric, and 1 small bowel), from February 1999 through August 2001, were studied. In each case, subserosal injections of isosulfan blue were used to identify the SLN. The SLNs were then sent fresh to the pathology laboratory for evaluation by IIC. A standard lymphadenectomy was performed in all cases. Postoperatively, the SLNs were evaluated by means of using hematoxylin and eosin staining. If these stains were normal, immunohistochemical analyses using carcinoembryonic antigen and cytokeratin were subsequently performed. SLNs were successfully identified in 46 cases (92%), and a total of 95 SLNs were harvested. The average number of SLNs was 1.9 with a range of one to six. More SLNs were found with gastric than with colonic lesions (2.8 vs. 1.8; P=.017). Evaluable IIC in 41 cases revealed metastatic disease in 10 SLNs, representing seven patients. Of the 34 patients with normal IIC, five were found to have positive SLNs on hematoxylin and eosin staining. An additional three patients were found to have positive SLNs only on immunohistochemical analysis. The overall sensitivity and specificity of IIC was 64% and 100%, respectively. This resulted in a positive predictive value of 100% and a negative predictive value of 86%. The use of IIC to evaluate SLNs from visceral malignancies is clearly feasible. When the IIC of the SLN is positive, the surgeon may feel confident that disease is actually present in the SLN. If there is a negative result, the technique may miss disease that is present on subsequent permanent sections. We do not recommend routine use of IIC; however, it may be of use in clinical trials.
尽管前哨淋巴结（SLN）定位技术最初是针对乳腺癌和黑色素瘤描述的，但目前正在对其在内脏恶性肿瘤治疗中的应用进行研究。尚无文献评估来自内脏部位的SLN的术中分析情况。我们评估了触摸印片术中印片细胞学检查（IIC）在评估因内脏恶性肿瘤而获取的SLN中的作用。对1999年2月至2001年8月期间涉及50例内脏恶性肿瘤（37例结肠癌、12例胃癌和1例小肠癌）的SLN定位程序进行了研究。在每例患者中，通过浆膜下注射异硫蓝来识别SLN。然后将SLN新鲜送检至病理实验室，通过IIC进行评估。所有病例均进行了标准淋巴结清扫术。术后，通过苏木精和伊红染色对SLN进行评估。如果这些染色结果正常，则随后进行癌胚抗原和细胞角蛋白的免疫组化分析。46例（92%）患者成功识别出SLN，共获取了95枚SLN。SLN的平均数量为1.9枚，范围为1至6枚。发现胃癌患者的SLN数量多于结肠癌患者（2.8枚对1.8枚；P = 0.017）。41例可评估IIC的患者中，10枚SLN发现有转移疾病，涉及7名患者。在IIC结果正常的34例患者中，5例在苏木精和伊红染色时发现SLN为阳性。另外3例患者仅在免疫组化分析时发现SLN为阳性。IIC的总体敏感性和特异性分别为64%和100%。这导致阳性预测值为100%，阴性预测值为86%。使用IIC评估内脏恶性肿瘤的SLN显然是可行的。当SLN的IIC结果为阳性时，外科医生可以确信SLN中实际存在疾病。如果结果为阴性，该技术可能会遗漏后续永久切片中存在的疾病。我们不建议常规使用IIC；然而，它可能在临床试验中有用。
