Kosugi Shin-Ichi, Nakagawa Satoru, Kanda Tatsuo, Odano Ikuo, Yajima Kazuhito, Kaneko Koji, Ohashi Manabu, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan.
Minim Invasive Ther Allied Technol. 2007;16(3):181-6. doi: 10.1080/13645700701384124.
The aim of this study was to assess whether the sentinel node concept could be applicable to clinically early carcinoma of the esophagus. We studied ten consecutive cT1N0 patients who underwent radical esophagectomy with regional lymph node dissection. On the day before surgery, 99m-Tc tin colloid was injected endoscopically around the primary tumor. Lymphoscintigraphy was also performed about three hours after injection. Immediately after surgery, the radioactivity of all dissected lymph nodes was measured with a hand-held gamma probe. The radioactivity and the metastatic status assessed by routine histopathologic examination were compared. A total of six patients had hot spots detected by lymphoscintigraphy, of which the detection rate was 60% (6 of 10). The ex vivo hot node detection rate was 90% (9 of 10). Three patients were found to have metastatic nodes. In one patient, sentinel node mapping failed to identify any hot spot or hot node. In the other two patients, the metastatic nodes did not correspond to hot nodes. The accuracy of hot node status was 77.8% (7 of 9), and the false-negative rate was 100% (2 of 2). The present study showed that radio-guided sentinel node detection is insufficiently reliable at present due to the high false-negative rate and low accuracy.
本研究的目的是评估前哨淋巴结概念是否适用于临床早期食管癌。我们研究了10例连续的cT1N0患者,这些患者接受了根治性食管切除术并进行了区域淋巴结清扫。在手术前一天,通过内镜在原发肿瘤周围注射99m - Tc锡胶体。注射后约三小时也进行了淋巴闪烁显像。手术后立即用手持式γ探测器测量所有清扫淋巴结的放射性。将通过常规组织病理学检查评估的放射性和转移状态进行比较。共有6例患者通过淋巴闪烁显像检测到热点,其检测率为60%(10例中的6例)。体外热点淋巴结检测率为90%(10例中的9例)。发现3例患者有转移淋巴结。在1例患者中,前哨淋巴结定位未能识别出任何热点或热点淋巴结。在另外2例患者中,转移淋巴结与热点淋巴结不对应。热点淋巴结状态的准确性为77.8%(9例中的7例),假阴性率为100%(2例中的2例)。本研究表明,由于高假阴性率和低准确性,目前放射性引导前哨淋巴结检测的可靠性不足。