Zhang Bin, Yan Dan-gui, Liu Lin, Niu Li-juan, An Chang-ming, Zhang Zong-min, Li Zheng-jiang, Xu Zhen-gang, Tang Ping-zhang
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2010 Oct;32(10):782-5.
To investigate the reliability and feasibility of sentinel lymph node biopsy (SLNB) of papillary thyroid carcinoma using combination of lymphoscintigraphy, the gamma probe and methylene blue staining techniques.
Twenty-three consecutive patients with thyroid papillary carcinoma were entered in the study between August 2007 and August 2009. All cases were without clinical evidence of cervical lymph node involvement. The (99)Tc(m)-dextran of 74 MBq (2mCi) was injected intratumorally under ultrasound guidance about 2 h to 5 h prior to surgery. Methylene blue was injected around the tumor during surgery. Preoperative lymphoscintigraphy, intra-operative hand-held gamma probe detecting and methylene blue staining techniques were used to detect the sentinel lymph node (SLN). SLN biopsies were sent to prepare frozen sections and the results were compared with specimen of routine selective neck dissection.
The SLNs were identified in all cases with the combination techniques. The SLN identification rates were 87.0% and 100% with methylene blue staining and lymphoscintigraphy plus probe scanning, respectively. Metastases in SLNs were revealed by frozen-section histology in 12 patients. In one case, SLNs frozen-section were negative, but metastasis was detected in routine histology. In other case both SLN and routine histology were negative, but metastasis was detected in non-SLN (level VI) neck dissection. The overall accuracy of the SLN biopsy was 91.3%, positive predictive value 100% and negative predictive value 81.8%.
The results seem the SLN biopsy technique is a feasible and valuable method for detecting cervical lymph node metastasis and is helpful to decide performing neck dissection in patients with cN0 papillary thyroid carcinoma.
探讨联合应用淋巴闪烁显像、γ探针及亚甲蓝染色技术对甲状腺乳头状癌进行前哨淋巴结活检（SLNB）的可靠性和可行性。
2007年8月至2009年8月连续纳入23例甲状腺乳头状癌患者进行研究。所有病例均无颈部淋巴结受累的临床证据。术前约2至5小时在超声引导下向瘤体内注射74MBq（2mCi）的（99）Tc（m）-右旋糖酐。术中在肿瘤周围注射亚甲蓝。采用术前淋巴闪烁显像、术中手持γ探针探测及亚甲蓝染色技术检测前哨淋巴结（SLN）。将SLN活检标本送检制备冰冻切片，并将结果与常规选择性颈清扫标本进行比较。
联合应用这些技术在所有病例中均成功识别出SLN。亚甲蓝染色及淋巴闪烁显像加探针扫描的SLN识别率分别为87.0%和100%。12例患者冰冻切片组织学检查显示SLN有转移。1例患者SLN冰冻切片为阴性，但常规组织学检查发现有转移。另1例患者SLN及常规组织学检查均为阴性，但在非SLN（Ⅵ区）颈清扫中发现有转移。SLN活检的总体准确率为91.3%，阳性预测值为100%，阴性预测值为81.8%。
结果显示SLN活检技术是检测颈部淋巴结转移的一种可行且有价值的方法，有助于决定cN0甲状腺乳头状癌患者是否行颈清扫术。
