Gretschel S, Warnick P, Bembenek A, Dresel S, Koswig S, String A, Hünerbein M, Schlag P M
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Department of Surgery and Surgical Oncology, Charité, Universitätsmedizin - Berlin, Campus Buch, Robert-Rössle-Klinik, Helios Klinikum Berlin, Berlin, Germany.
Eur J Surg Oncol. 2008 Aug;34(8):890-894. doi: 10.1016/j.ejso.2007.11.013. Epub 2008 Feb 21.
Although 15-25% of patients with anal cancer present with superficial inguinal lymph node metastases but the routine application of groin irradiation is controversial because of serious side effects. Inguinal sentinel lymph node biopsy (SLNB) can be used to select patients appropriately for inguinal radiation. The study evaluates the efficiency and clinical impact of SLNB.
Forty patients with anal cancer underwent 1 ml Tc(99m)-Nanocolloid injection in four sites around the tumour. Patients with inguinal radio colloid enrichment were selected for sentinel lymph node biopsy (SLNB). Lymph node status was examined by haematoxylin and eosin (H&E) as well as immunohistochemistry-staining. All SLN-positive patients were scheduled for inguinal radiation; SLN-negative patients with T1 and early T2 tumours were not scheduled for inguinal radiation.
SLN were detected in 36/40 patients. Three common patterns of lymphatic drainage were observed: mesenterial, iliacal and inguinal. Twenty patients with inguinal SLN underwent SLN-biopsy. 6/20 patients were SLN-positive. In 10/20 patients SLNB altered the therapy plan--four patients with T1-tumours and positive SLN had additional groin irradiation, whereas 6 patients with small T2-tumors and tumour-free inguinal SLN did not undergo inguinal irradiation.
Inguinal sentinel node biopsy in anal cancer is efficient and could assist in the decision for inguinal radiation. The validity and safety of the proposed therapeutic algorithm has to be proven by a larger, prospective study.
尽管15%-25%的肛管癌患者存在浅表腹股沟淋巴结转移，但由于严重的副作用，腹股沟区放疗的常规应用存在争议。腹股沟前哨淋巴结活检（SLNB）可用于适当选择腹股沟放疗的患者。本研究评估了SLNB的有效性和临床影响。
40例肛管癌患者在肿瘤周围四个部位注射1毫升锝（99m）-纳米胶体。选择腹股沟放射性胶体富集的患者进行前哨淋巴结活检（SLNB）。通过苏木精和伊红（H&E）以及免疫组织化学染色检查淋巴结状态。所有SLN阳性患者均计划接受腹股沟放疗；T1期和早期T2期肿瘤且SLN阴性的患者不计划接受腹股沟放疗。
40例患者中36例检测到SLN。观察到三种常见的淋巴引流模式：肠系膜、髂骨和腹股沟。20例腹股沟SLN患者接受了SLNB。20例患者中有6例SLN阳性。20例患者中有10例SLNB改变了治疗方案——4例T1期肿瘤且SLN阳性的患者额外接受了腹股沟放疗，而6例T2期小肿瘤且腹股沟SLN无转移的患者未接受腹股沟放疗。
肛管癌腹股沟前哨淋巴结活检有效，可协助决定是否进行腹股沟放疗。所提出的治疗方案的有效性和安全性必须通过更大规模的前瞻性研究来证实。
