Matsuzuka Takashi, Kano Makoto, Ogawa Hiroshi, Miura Tomohiro, Tada Yasuhiro, Matsui Takamichi, Yokoyma Shuji, Suzuki Yasushi, Suzuki Masahiro, Omori Koichi
Department of Otolaryngology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Laryngoscope. 2008 Apr;118(4):646-9. doi: 10.1097/MLG.0b013e3181613aa6.
The objective of this study is to evaluate lymph node mapping for clinically positive neck metastasis using a sentinel node navigation technique.
99mTc-labeled rhenium sulfide was injected as a radiotracer in 10 patients with squamous cell carcinoma of the tongue. After surgery, lymph nodes were classified into two categories according to the radioactive accumulation: nodes with radioactivity and nodes without radioactivity. The ratio of the metastatic area (RMA) of pathologically metastatic lymph nodes was measured.
In 5 of 10 cases, all of the metastatic nodes had radioactive accumulation. In one case with three metastatic nodes, radioactivity was not detected in one metastatic node, although it was detected in the other two nodes. In the other four cases, there were no radioactivities in any of the metastatic nodes. RMA of lymph nodes in which radioactivity was not detected was higher than that of lymph nodes in which radioactivity was detected. None of the nodes in which radioactivity was detected was fully occupied by metastatic carcinoma cells. In each case, in comparing the clinically positive lymph nodes, RMA of the nodes in which no radioactivity was detected was higher than that of the nodes in which radioactivity was detected.
The principle behind the sentinel node technique is detection of the node that has the most lymph flow from the tumor through injection of the tracer into the circumference of the tumor. When no radioactive accumulation is found in clinically positive metastatic lymph nodes, the possibility of metastasis to other lymph nodes should be highly suspected.
本研究的目的是使用前哨淋巴结导航技术评估临床阳性颈部转移的淋巴结定位。
对10例舌鳞状细胞癌患者注射99mTc标记的硫化铼作为放射性示踪剂。手术后，根据放射性聚集情况将淋巴结分为两类：有放射性的淋巴结和无放射性的淋巴结。测量病理转移淋巴结的转移面积比（RMA）。
10例中有5例，所有转移淋巴结均有放射性聚集。在1例有3个转移淋巴结的病例中，1个转移淋巴结未检测到放射性，尽管另外2个淋巴结检测到了放射性。在其他4例中，任何转移淋巴结均无放射性。未检测到放射性的淋巴结的RMA高于检测到放射性的淋巴结的RMA。检测到放射性的淋巴结中没有一个被转移癌细胞完全占据。在每种情况下，比较临床阳性淋巴结时，未检测到放射性的淋巴结的RMA高于检测到放射性 的淋巴结的RMA。
前哨淋巴结技术的原理是通过将示踪剂注射到肿瘤周围来检测从肿瘤引流淋巴液最多的淋巴结。当临床阳性转移淋巴结中未发现放射性聚集时，应高度怀疑有转移至其他淋巴结的可能性。
