Department of Surgery, Scientific Institute San Raffaele Hospital, Milan, Italy.
Ann Surg Oncol. 2011 Feb;18(2):365-70. doi: 10.1245/s10434-010-1275-x. Epub 2010 Aug 28.
Radiochemotherapy is the standard treatment for patients with carcinoma of the anal canal. Therefore, a surgical specimen is not usually obtained. Inguinal lymph node metastases cannot be accurately predicted by either clinical examination or imaging techniques. In this study, we applied the sentinel node technique in patients with anal canal squamous-cell carcinoma to determine whether this provided more reliable staging of tumors.
From May 2007 to May 2009, we enrolled 11 patients (7 women) with a mean age 65 (range 39-80) years with squamous-cell carcinoma of the anal canal and clinically and radiologically negative groin lymph nodes. The patients were staged with endorectal ultrasound, computed tomographic scan, magnetic resonance imaging of the pelvis, and positron emission tomography. There were two T1, four T2, and five T3 tumors (International Union Against Cancer classification). Lymphoscintigraphy with peritumoral 99mTc colloid injection was performed 16 to 18 h before surgery. During the surgery, patent blue dye was injected peritumorally, and the sentinel inguinal node was identified by a handheld gamma probe and dye visualization.
The sentinel lymph node was detected in all 11 patients by scintigraphy; in 9 cases, the lymph node was in the inguinal region. All of these patients underwent radioguided node biopsy, and a total of 12 lymph nodes were removed. The average diameter of the resected nodes was 8 (range 4-20) mm. No serious complications occurred. In three patients, metastases were identified in the lymph node.
Sentinel node biopsy is a more accurate method than clinical or radiological techniques to stage the disease of patients with anal carcinoma.
放化疗是肛管鳞癌患者的标准治疗方法。因此，通常不会获得手术标本。临床检查或影像学技术均无法准确预测腹股沟淋巴结转移。在这项研究中，我们将前哨淋巴结技术应用于肛管鳞癌患者，以确定其是否能更可靠地分期肿瘤。
2007 年 5 月至 2009 年 5 月，我们纳入了 11 例（7 名女性）年龄均数为 65（范围 39-80）岁的肛管鳞癌且临床和影像学检查腹股沟淋巴结阴性的患者。患者的分期采用直肠内超声、计算机断层扫描、骨盆磁共振成像和正电子发射断层扫描。其中 2 例 T1 期、4 例 T2 期和 5 例 T3 期肿瘤（国际抗癌联盟分类）。术前 16-18 小时行肿瘤周围 99mTc 胶体淋巴显像。术中，肿瘤周围注射美蓝染料，使用手持式伽马探针和染料可视化来识别前哨腹股沟淋巴结。
11 例患者的淋巴闪烁显像均检测到前哨淋巴结；9 例位于腹股沟区。所有患者均行放射性示踪淋巴结活检，共切除 12 枚淋巴结。切除淋巴结的平均直径为 8（范围 4-20）mm。无严重并发症发生。3 例患者的淋巴结中发现转移。
与临床或影像学技术相比，前哨淋巴结活检是一种更准确的分期方法，可用于肛管癌患者。
