Perera D, Pathma-Nathan N, Rabbitt P, Hewett P, Rieger N
University Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
Dis Colon Rectum. 2003 Aug;46(8):1027-9; discussion 1030-1. doi: 10.1007/s10350-004-7276-8.
The majority of anal tumors are squamous-cell carcinomas. These may be tumors of the anal canal or margin. They are best treated by combination of chemotherapy and radiotherapy. T1 and T2 tumors in this regime do not receive radiotherapy to the inguinal regions despite approximately 5 to 10 percent incidence of inguinal lymph node involvement. If the nodal status of the inguinal region could be accurately assessed, then a more tailored radiotherapy regime may be given. This article describes a novel method of assessment of the status of the inguinal lymph nodes in patients.
Patients with anal squamous-cell carcinoma had four injections of 0.2 ml of antimony sulfide (30 MBq) around the tumor. Under a gamma camera, a distant high-intensity signal was located, and this point was marked on the overlying skin using an indelible ink pen. In the operating theater, patent blue dye was injected all around the tumor. The localized lymph node was removed and sent for histopathology.
This procedure was performed on 12 patients. The sentinel node was localized to the inguinal region and removed in eight of these patients. In two patients, metastatic squamous-cell carcinoma was identified histologically in the sentinel node.
We advocate that this as a safe technique for detecting metastatic disease in the inguinal nodes in patients with anal squamous-cell carcinoma.
大多数肛管肿瘤为鳞状细胞癌。这些肿瘤可能位于肛管或边缘。最佳治疗方法是化疗与放疗联合。在此治疗方案中，T1和T2期肿瘤尽管腹股沟淋巴结受累发生率约为5%至10%，但不接受腹股沟区放疗。如果能准确评估腹股沟区的淋巴结状态，那么可以给予更具针对性的放疗方案。本文描述了一种评估患者腹股沟淋巴结状态的新方法。
肛管鳞状细胞癌患者在肿瘤周围注射4次0.2毫升硫化锑（30兆贝可）。在γ相机下，找到一个远处的高强度信号，并使用不可擦除的墨水笔在覆盖的皮肤上标记该点。在手术室中，在肿瘤周围注射专利蓝染料。切除定位的淋巴结并送去做组织病理学检查。
对12例患者进行了该操作。前哨淋巴结定位于腹股沟区，其中8例患者的前哨淋巴结被切除。2例患者的前哨淋巴结经组织学检查发现有转移性鳞状细胞癌。
我们主张将此作为检测肛管鳞状细胞癌患者腹股沟淋巴结转移疾病的一种安全技术。
