Chan Siew H, Ng Colin, Looi Lai M
Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
ANZ J Surg. 2008 Sep;78(9):775-9. doi: 10.1111/j.1445-2197.2008.04648.x.
Isosulfan blue is not available for clinical use in Malaysia. This study describes the use of methylene blue as an alternative to isosulfan blue in colorectal sentinel node mapping.
Methylene blue dye was injected around colonic and rectal tumours and the first blue-stained nodes were suture tagged and harvested after standard colorectal resection. Standard histopathological examination was then carried out to detect nodal metastasis. All negative sentinel lymph nodes (SLN) were subjected to 10 further step sectioning and immunoperoxidase staining for cytokeratin 20 to detect tumour deposits.
Thirty-one patients were enrolled from August 2005 to July 2006. Twenty-five attempts at identifying the SLN were successful (80.7%). Of the 18 (58.1%) who had nodal metastases (stage III), 3 had negative SLN but positive other lymph nodes (false-negative rate of 21.4%). In one (4%), the SLN was the exclusive site of metastasis.
Methylene blue can be used as an alternative sentinel node marker for rectal cancer (above the peritoneal reflection) and colonic cancer.
异硫蓝在马来西亚不可用于临床。本研究描述了亚甲蓝作为异硫蓝的替代品在结直肠前哨淋巴结定位中的应用。
在结肠和直肠肿瘤周围注射亚甲蓝染料，在标准结直肠切除术后，对首个被染成蓝色的淋巴结进行缝线标记并切除。然后进行标准组织病理学检查以检测淋巴结转移。所有阴性前哨淋巴结（SLN）均进行10次进一步的连续切片及细胞角蛋白20免疫过氧化物酶染色，以检测肿瘤沉积物。
2005年8月至2006年7月共纳入31例患者。25次识别SLN的尝试成功（80.7%）。在18例（58.1%）有淋巴结转移（III期）的患者中，3例SLN为阴性但其他淋巴结为阳性（假阴性率为21.4%）。1例（4%）患者中，SLN是唯一的转移部位。
亚甲蓝可作为直肠癌（腹膜反折以上）和结肠癌的前哨淋巴结标记物的替代品。
