Sevcík L, Klát J, Gráf P, Curík R, Kraft O, Jalůvková Z
Porodnicko-Gynekologická Klinika FN Ostrava.
Klin Onkol. 2008;21(1):26-30.
The aim of the study is to analyze the feasibility of intraoperative sentinel lymph nodes (SLN) detection using gamma detection probe and blue dye in patients with cervical cancer.
Prospective clinical study. 106 patients with cervical cancer were included into the study in the period from May 2004 to November 2006.
Patients were divided into three groups according to the tumor volume. Lymphoscintigraphy was performed following an injection of 99m Tc-labeled nanocolloid and intraoperatively the SLN were identified visually after marking of lymphatic vessels with blue dye and further detected using a handheld gamma detection probe. The SLN were histologically and immunohistochemically analyzed. Total number of 309 SLN with an average of 2.9 per patient were identified. The SLN detection rate was 94.3% per patient, 84.4 % per side, and depended on the tumor volume. Metastatic disease was detected in 39 patients (36.8%) and micrometastatic disease in 15 patients (14.2%). Sensitivity and negative predictive value calculated were 93.9% and 98.0%, false negative rate reached 5.1.
Intraoperative detection of SLN using combination of technecium-99-labeled nanocolloid and blue dye represents a feasible, safe and accurate technique to identify lymphatic spreading in stages IA2-IB1 of cervical cancer.
本研究旨在分析在宫颈癌患者中使用γ探测针和蓝色染料进行术中前哨淋巴结（SLN）检测的可行性。
前瞻性临床研究。2004年5月至2006年11月期间，106例宫颈癌患者被纳入本研究。
根据肿瘤体积将患者分为三组。注射99m Tc标记的纳米胶体后进行淋巴闪烁显像，术中在淋巴管用蓝色染料标记后肉眼识别SLN，并用手持式γ探测针进一步检测。对SLN进行组织学和免疫组织化学分析。共识别出309个SLN，平均每位患者2.9个。SLN的患者检出率为94.3%，单侧检出率为84.4%，且取决于肿瘤体积。39例患者（36.8%）检测到转移病灶，15例患者（14.2%）检测到微转移病灶。计算得出的灵敏度和阴性预测值分别为93.9%和98.0%，假阴性率达5.1。
术中联合使用99锝标记的纳米胶体和蓝色染料检测SLN是一种可行、安全且准确的技术，可用于识别宫颈癌IA2 - IB1期的淋巴转移情况。
