Takami Hiroshi, Sasaki Kazuyoshi, Ikeda Yoshifumi, Tajima Gengo, Kameyama Kaori
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Asian J Surg. 2003 Jul;26(3):145-8. doi: 10.1016/S1015-9584(09)60373-0.
To determine the feasibility of sentinel lymph node biopsy as a means of evaluating the cervical lymph nodes of patients with papillary thyroid cancer.
Isosulfan blue dye was injected around the tumour of 68 patients with papillary thyroid cancer; sentinel lymph node biopsy was performed in addition to subtotal thyroidectomy and central and modified lateral neck lymph node dissections. Surgical specimens were examined by routine processing to determine whether metastasis was present.
Sentinel lymph nodes were identified in 63 (92.6%) of the 68 patients. There was concordance between the sentinel lymph node status and the final regional lymph node status in 58 (92.1%) of the 63 patients. There were five false-negative cases. Sentinel lymph node biopsy had a sensitivity of 87.5% (35/40), specificity of 100% (23/23), positive predictive value of 100% (35/35), negative predictive value of 82.1% (23/28), and accuracy of 92.1% (58/63).
Sentinel lymph node biopsy may allow discrimination between patients with true lymph-node-negative papillary thyroid carcinoma and those with non-palpable metastatic lymph nodes. It may also be helpful in diagnosing metastases and avoiding unnecessary lymph node dissection in thyroid cancer.
确定前哨淋巴结活检作为评估甲状腺乳头状癌患者颈部淋巴结的一种方法的可行性。
对68例甲状腺乳头状癌患者在肿瘤周围注射异硫蓝染料；除甲状腺次全切除术及中央区和改良侧颈淋巴结清扫术外，还进行前哨淋巴结活检。手术标本经常规处理后检查是否存在转移。
68例患者中有63例（92.6%）发现了前哨淋巴结。63例患者中有58例（92.1%）前哨淋巴结状态与最终区域淋巴结状态一致。有5例假阴性病例。前哨淋巴结活检的敏感性为87.5%（35/40），特异性为100%（23/23），阳性预测值为100%（35/35），阴性预测值为82.1%（23/28），准确性为92.1%（58/63）。
前哨淋巴结活检可区分真正淋巴结阴性的甲状腺乳头状癌患者和有不可触及转移淋巴结的患者。它也可能有助于诊断转移并避免甲状腺癌患者进行不必要的淋巴结清扫。
