Department of Surgery, Royal Free and University College Medical School, University College London, London, UK.
Br J Surg. 2010 Aug;97(8):1232-9. doi: 10.1002/bjs.7095.
Intraoperative diagnosis of sentinel node metastases enables an immediate decision to proceed to axillary lymph node dissection, avoiding a second operation in node-positive women with breast cancer.
An optical scanner was developed that interrogated the cut surface of bivalved, but otherwise unprocessed, sentinel lymph nodes with pulses of white light by elastic scattering spectroscopy (ESS). The scattered light underwent spectral analysis, and individual spectra were initially correlated with conventional histology to develop a diagnostic algorithm. This algorithm was used to create false colour-coded maps of scans from an independent set of nodes, and the optimal criteria for discriminating between normal and cancer spectra were defined statistically.
The discriminant algorithm was developed from a training set of 2989 spectra obtained from 30 metastatic and 331 normal nodes. Subsequent scans from 129 independent nodes were analysed. The scanner detected macrometastases (larger than 2 mm) with a sensitivity of 76 per cent (69 per cent including micrometastases) and specificity of 96 per cent.
In this proof-of-principle study, the ESS results were comparable with current intraoperative diagnostic techniques of lymph node assessment.
术中诊断前哨淋巴结转移可使淋巴结阳性的乳腺癌患者能够立即决定进行腋窝淋巴结清扫，避免二次手术。
我们开发了一种光学扫描仪，用弹性散射光谱（ESS）对双瓣但未经其他处理的前哨淋巴结的切面进行白光脉冲探测。对散射光进行光谱分析，并将初始的单个光谱与常规组织学相关联，以开发诊断算法。该算法用于创建来自另一组淋巴结的扫描的假彩色编码图，并通过统计学方法定义了区分正常和癌症光谱的最佳标准。
判别算法是从 30 个转移性和 331 个正常淋巴结获得的 2989 个光谱的训练集中开发的。随后分析了 129 个独立淋巴结的扫描。该扫描仪检测到宏转移（大于 2 毫米）的灵敏度为 76%（包括微转移在内的灵敏度为 69%），特异性为 96%。
在这项原理验证研究中，ESS 结果与当前的术中淋巴结评估诊断技术相当。
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