Damin Daniel C, Rosito Mario A, Gus Pedro, Spiro Bernardo L, Amaral Beatriz B, Meurer Luise, Cartel Andre, Schwartsmann Gilberto
Departments of Colorectal Surgery, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Dis Colon Rectum. 2003 Aug;46(8):1032-7. doi: 10.1007/s10350-004-7277-7.
This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal.
Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3).
Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal.
The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.
本研究旨在评估前哨淋巴结活检术在肛管表皮样癌患者中的可行性。
2001年2月至2002年11月，14例肛管表皮样癌且无腹股沟受累临床证据的患者被前瞻性纳入本研究。前哨淋巴结活检术包括术前用99m锝标记的右旋糖酐500在肿瘤周围注射进行淋巴闪烁显像，以及术中用γ探测仪检测前哨淋巴结。还在肿瘤周边注射专利蓝V染料以利于直接识别染成蓝色的淋巴结。切除后，对前哨淋巴结进行苏木精-伊红染色及全细胞角蛋白（抗原A1和A3）免疫组化研究。
所有患者均成功检测并切除了前哨淋巴结。肿瘤大小与腹股沟淋巴引流模式之间无相关性。位于肛管中线的肿瘤在9例中有8例出现双侧前哨淋巴结。总共切除了23个前哨淋巴结。1例患者（7.1%）的一个淋巴结在免疫组化染色中被确定为转移性癌阳性。手术并发症极少。
标准化技术在肛管癌腹股沟前哨淋巴结取样中安全且高效。它也被证明是检测临床正常淋巴结中微转移灶的有用工具。我们的早期结果表明，前哨淋巴结活检术可能在指导对肛管癌患者采取更具选择性的治疗方法中发挥作用。有必要在更大规模的患者群体中进行进一步研究以确定该方法的敏感性和特异性。
