Liu Ming-Bo, Qi Yong-Fa, Tang Ping-Zhang, Xu Zhen-Gang, Chen Mo-Qi, Liu Shao-Yan, Yin Yu-Lin, Liu Wen-Sheng
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Ke Za Zhi. 2004 Jun;39(6):360-3.
To assess the feasibility of sentinel lymph node (SLN) radiolocalization in stage in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel lymph node could be prognostic of regional micrometastatic disease.
A prospective trial was made on the application sentinel lymph node radiolocalization in 10 patients with NO squamous cell carcinoma of the head and neck region. For each patient a peritumoral submucosal injection of filtered technetium 99m prepared with dextran colloid (99mTc-DX) was performed immediately. After 30 minutes, focal areas of accumulation corresponding to sentinel lymph nodes (SLN) were marked on the skin surface. The SLN was localized by lymphoscintigraphy and intraoperatively through the intact skin by a hand-held gamma-probe. SLN was defined as the count of lymph node could be detected 4 times more than that of background. Complete neck dissections were performed, and SLNs were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen.
SLN radiolocalization accurately identified one or more SLNs in the ten cases. 3 of 10 cases revealed occult metastatic disease. Therefore the negative metastasis rate was 30% (3/10). The positive rate of SLN and nonsentinel lymph node (NSLN) were 22.7% (5/22) and 0.4% (1/247) respectively. Serial sectioning (SS) and immunohistochemical (IHC) on SLNs would reduce the false-negative rate of sentinel lymph node biopsy (SLNB). There was no instance in which SLN was negative for micrometastatic disease while being positive in a nonsentinel lymph node.
SLN evaluation in NO neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis. Although SLN radiolocalization in head and neck squamous cell carcinoma may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.
评估前哨淋巴结（SLN）放射性定位在头颈部鳞状细胞癌中的可行性，并深入了解前哨淋巴结是否可作为区域微转移疾病的预后指标。
对10例头颈部区域NO期鳞状细胞癌患者进行前哨淋巴结放射性定位的前瞻性试验。对每位患者立即在肿瘤周围黏膜下注射用葡聚糖胶体配制的过滤锝99m（99mTc-DX）。30分钟后，在皮肤表面标记与前哨淋巴结（SLN）相对应的聚集灶。通过淋巴闪烁显像定位SLN，并在术中通过手持式γ探头经完整皮肤定位。SLN定义为淋巴结计数比背景计数高4倍以上。进行全颈清扫，并识别SLN以便后续进行组织学评估，并与其余淋巴结切除标本进行比较。
SLN放射性定位在10例病例中准确识别出一个或多个SLN。10例中有3例显示隐匿性转移疾病。因此，阴性转移率为30%（3/10）。SLN和非前哨淋巴结（NSLN）的阳性率分别为22.7%（5/22）和0.4%（1/247）。对SLN进行连续切片（SS）和免疫组织化学（IHC）检查可降低前哨淋巴结活检（SLNB）的假阴性率。没有出现SLN对微转移疾病为阴性而在非前哨淋巴结中为阳性的情况。
对头颈部鳞状细胞癌NO期颈部进行SLN评估准确可行，似乎能充分预测隐匿性转移的存在。尽管头颈部鳞状细胞癌的SLN放射性定位可能会潜在地减少区域淋巴结处理的时间、成本和发病率，但在确定其作用之前还需要更多的技术经验。
