Institute of Pathology, Klinikum Augsburg, Augsburg, Germany.
Ann Surg Oncol. 2010 Oct;17(10):2647-55. doi: 10.1245/s10434-010-1030-3. Epub 2010 Mar 24.
We recently introduced ex vivo, intra-arterial methylene blue injection as a simple method to improve the lymph node (LN) harvest in gastrointestinal cancer. We now combined it with a novel ex vivo sentinel lymph node (evSLN) mapping technique.
evSLN mapping was performed by subserosal (n = 20) or submucosal (n = 30) India ink injection. Subsequently, methylene blue was injected intra-arterially to enhance visibility of all LNs to improve the overall LN harvest. Manual LN dissection was carried out after fixing overnight. evSLNs nodes were identified by detecting carbon particles during histological examination. In primary node-negative cases, all detected LNs were step sectioned and immunohistochemically stained for pan-cytokeratin.
India ink injection was easy to perform. Methylene blue injection failed in 1 case. The mean lymph node harvest was 42 ± 18 LNs, and the SLN detection rate was 78%. The sensitivity for detecting metastases was 75%. The mean SLN number was 3 ± 1. LN metastases were found in 20 of 47 malignant cases (43%). Skip metastases occurred in 4 cases. Of these cases, 3 showed involvement of at least 1 entire LN. True upstaging (N0 → N1mi) was found in 1 of 23 cases (4%) within a SLN after advanced evaluation.
Combination of methylene blue technique and ex vivo sentinel mapping is feasible, easy to perform, and cost effective. It guarantees an optimal LN harvest and has the potential to heighten the sensitivity of metastasis detection.
我们最近介绍了一种经动脉亚甲蓝注射的体外方法，作为一种提高胃肠道癌淋巴结（LN）检出率的简单方法。我们现在将其与一种新的体外前哨淋巴结（evSLN）绘图技术相结合。
通过黏膜下（n=20）或黏膜下（n=30）印度墨水注射进行 evSLN 绘图。随后，通过动脉内注射亚甲蓝来提高所有 LN 的可视性，从而提高整体 LN 检出率。固定过夜后进行手动 LN 解剖。通过在组织学检查中检测碳颗粒来识别 evSLN 节点。在原发性淋巴结阴性病例中，所有检测到的淋巴结均进行连续切片，并进行 pan-cytokeratin 免疫组织化学染色。
印度墨水注射易于进行。1 例亚甲蓝注射失败。平均淋巴结检出数为 42±18 个，SLN 检出率为 78%。检测转移的敏感性为 75%。平均 SLN 数为 3±1。47 例恶性病例中有 20 例（43%）发现 LN 转移。4 例发生跳跃性转移。这些病例中，有 3 例至少有 1 个整个 LN 受累。经过高级评估，23 例（4%）中的 1 例 SLN 中发现真正的分期升级（N0→N1mi）。
亚甲蓝技术和体外前哨绘图的结合是可行的、易于操作的，且具有成本效益。它保证了最佳的 LN 检出率，并有可能提高转移检测的敏感性。
