Dan Adrian G, Saha Sukamal, Monson Keith M, Wiese David, Schochet Elie, Barber Kimberly R, Ganatra Balvant, Desai Delip, Kaushal Sunil
Department of Surgery, Michigan State University, McLaren Regional Medical Center, Flint, USA.
Arch Surg. 2004 Nov;139(11):1180-4. doi: 10.1001/archsurg.139.11.1180.
Ten percent fluorescein may be successfully used as an alternative to 1% Lymphazurin (1% isosulfan blue; US Surgical Corp, North Haven, Conn) in sentinel lymph node (SLN) mapping for the accurate staging of colorectal tumors.
Review of prospectively gathered data.
University-affiliated regional medical center.
Sentinel lymph node mapping was performed in 120 consecutive patients with colorectal malignancies.
The first 1 to 4 blue nodes detected within 5 minutes were designated as Lymphazurin-detected SLNs. The first 1 to 4 fluorescent nodes seen under the Wood light were designated as fluorescein-detected SLNs. Multilevel serial sections for hematoxylin-eosin and immunohistochemistry studies for cytokeratin were performed on all SLNs.
Successful mapping, accuracy, skip metastasis, adverse reactions, occult micrometastases detection, and cost.
Mapping was successful using Lymphazurin in 99% of the patients vs 97% of the patients using fluorescein (P =.89). The accuracy of predicting nodal metastases with each tracer was 95.8% vs 93.1%, respectively (P =.82). The skip metastases rate was 4.2% for Lymphazurin vs 6.9% for fluorescein (P =.37). The 5 patients in whom nodal disease was only identified as occult micrometastasis in the SLNs had a total of 5 SLNs, all of which were identified by both tracers. No adverse reactions occurred. The cost for Lymphazurin was $99.00, while the cost for fluorescein was $2.10.
With the exception of cost, there were no statistically significant differences between the 2 dyes. While easy availability and lower cost remain distinct advantages of fluorescein, Lymphazurin remains the gold standard. In patients with known hypersensitivity to Lymphazurin and when availability and cost are an issue, fluorescein may be used effectively for SLN mapping in colorectal tumors.
在结直肠肿瘤的准确分期中，10%的荧光素可成功替代1%的亚甲蓝（1%异硫蓝；美国外科公司，北港，康涅狄格州）用于前哨淋巴结（SLN）定位。
回顾前瞻性收集的数据。
大学附属地区医疗中心。
对120例连续的结直肠恶性肿瘤患者进行前哨淋巴结定位。
在5分钟内检测到的前1至4个蓝色淋巴结被指定为亚甲蓝检测到的SLN。在伍德灯下看到的前1至4个荧光淋巴结被指定为荧光素检测到的SLN。对所有SLN进行苏木精-伊红染色的多层连续切片和细胞角蛋白免疫组织化学研究。
成功定位、准确性、跳跃转移、不良反应、隐匿性微转移检测和成本。
使用亚甲蓝成功定位的患者为99%，使用荧光素成功定位的患者为97%（P = 0.89）。每种示踪剂预测淋巴结转移的准确率分别为95.8%和93.1%（P = 0.82）。亚甲蓝的跳跃转移率为4.2%，荧光素为6.9%（P = 0.37）。5例患者的淋巴结疾病仅在前哨淋巴结中被鉴定为隐匿性微转移，共有5个前哨淋巴结，两种示踪剂均能检测到。未发生不良反应。亚甲蓝的成本为99.00美元，而荧光素的成本为2.10美元。
除成本外，两种染料之间无统计学显著差异。虽然荧光素易于获得且成本较低仍是明显优势，但亚甲蓝仍是金标准。对于已知对亚甲蓝过敏且存在可用性和成本问题的患者，荧光素可有效用于结直肠肿瘤的前哨淋巴结定位。
