结直肠癌的体外前哨淋巴结“定位”
Ex vivo sentinel lymph node "mapping" in colorectal cancer.
作者信息
van Schaik P M, van der Linden J C, Ernst M F, Gelderman W A H, Bosscha K
机构信息
Department of Surgery, Jeroen Bosch Hospital, Tolbrugstraat 11, 5211 RW 's-Hertogenbosch, The Netherlands.
出版信息
Eur J Surg Oncol. 2007 Dec;33(10):1177-82. doi: 10.1016/j.ejso.2007.03.006. Epub 2007 Apr 20.
BACKGROUND
The purpose of this study was to evaluate the feasibility and reliability of ex vivo sentinel lymph node mapping in patients with colorectal cancer.
METHODS
In the period January-June 2006, 44 consecutive patients underwent curative surgery for colorectal cancer. In patients with colon and rectal cancer, 0.5-2 ml of Patent Blue Dye was injected submucosally. The injection sites where then gently massaged for 5 min.
RESULTS
In 96% of the patients with colon cancer and 94% of the patients with rectal cancer, at least one sentinel lymph node was found. There were no patients with a false negative sentinel node. The sensitivity was 100% with a negative predictive value of 100%. In 19% of the patients with colon cancer and 18% of the patients with rectal cancer the sentinel node was the exclusive site of lymph node metastases. After additional sectioning and staining, 7 of the 23 patients (30%) with a Dukes B colorectal cancer were upstaged.
CONCLUSION
The technique of ex vivo sentinel lymph node mapping is technically feasible with high sensitivity, high negative predictive value and a high rate of upstaging. The next step is to investigate, if detection of micro-metastases is associated with decreased survival and/or increased local recurrence rates.
背景
本研究的目的是评估结直肠癌患者体内前哨淋巴结定位的可行性和可靠性。
方法
在2006年1月至6月期间，44例连续性结直肠癌患者接受了根治性手术。对于结肠癌和直肠癌患者，将0.5 - 2毫升专利蓝染料黏膜下注射。然后对注射部位轻轻按摩5分钟。
结果
96%的结肠癌患者和94%的直肠癌患者中发现了至少一个前哨淋巴结。没有患者出现前哨淋巴结假阴性。敏感性为100%，阴性预测值为100%。19%的结肠癌患者和18%的直肠癌患者中，前哨淋巴结是淋巴结转移的唯一部位。经过额外的切片和染色后，23例杜克B期结直肠癌患者中有7例（30%）分期上调。
结论
体内前哨淋巴结定位技术在技术上是可行的，具有高敏感性、高阴性预测值和高分期上调率。下一步是研究微转移的检测是否与生存率降低和/或局部复发率增加相关。
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