Hu Guohua, Zhong Shixun, Xiao Qing, Li Zhongwan, Hong Suling
Department of Otolaryngology, First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Ann Otol Rhinol Laryngol. 2011 May;120(5):345-50. doi: 10.1177/000348941112000511.
We sought to analyze the characteristics of radioactive lymph nodes with metastatic disease and to explore methods for the localization of sentinel lymph nodes (SLNs) with radionuclide in clinically N0 laryngeal and hypopharyngeal cancer.
Forty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient, a peritumoral submucosal injection of 99mTc-labeled sulfur colloid was administered, and lymph node mapping was performed by lymphoscintigraphy 2 hours after injection. The SLNs were localized during operation by a hand-held gamma probe 10 to 12 hours after the injection, and we defined the radioactive counts from the parotideomasseteric region as background values. All lymph nodes that had accumulated radioactivity were harvested and initially termed as SLNs. Selective neck dissection was performed in all patients. The SLN specimens were sent for formal paraffin-embedded sectioning, serial sectioning, and immunohistochemical assay. The results were compared to those for the remaining lymphadenectomy specimen. Resection of the primary tumor depended on its location and the T classification.
Sentinel lymph nodes were identified in 41 of 45 patients (51 necks). Sentinel lymph nodes with occult metastases were found in 13 patients (15 necks). In a false-negative case, metastasis was found in a nonsentinel lymph node in 1 of the neck specimens. The SLN identification rate was 92.7%, the sensitivity was 93.7%, the false-negative rate was 6.3%, and the accuracy was 98.0%. In 11 of the 15 necks (73.3%) with pathologically positive SLNs, metastasis was found in the node with the highest radioactivity. Harvesting the first 3 nodes with the highest radioactive counts may identify patients with occult metastatic disease.
Excision of the first 3 SLNs with the highest radioactive counts can be used to accurately identify the status of cervical lymph node metastases in patients with clinically N0 laryngeal or hypopharyngeal cancer.
我们试图分析发生转移的放射性淋巴结的特征，并探索在临床N0期喉癌和下咽癌中用放射性核素定位前哨淋巴结（SLN）的方法。
招募了45例T1 - T4期且临床N0期的喉癌和下咽癌患者。对每位患者在肿瘤周围黏膜下注射99mTc标记的硫化胶体，注射2小时后通过淋巴闪烁显像进行淋巴结定位。注射后10至12小时在手术中用手持γ探测器定位SLN，我们将腮腺咬肌区域的放射性计数定义为背景值。所有摄取放射性的淋巴结均被切除并最初称为SLN。所有患者均行选择性颈清扫术。将SLN标本送去进行常规石蜡包埋切片、连续切片和免疫组化分析。将结果与其余淋巴结清扫标本的结果进行比较。原发肿瘤的切除取决于其位置和T分期。
45例患者中的41例（51侧颈部）发现了前哨淋巴结。13例患者（15侧颈部）发现了隐匿性转移的前哨淋巴结。在1例假阴性病例中，1侧颈部标本的非前哨淋巴结发现了转移。SLN识别率为92.7%，敏感性为93.7%，假阴性率为6.3%，准确率为98.0%。在15侧病理检查前哨淋巴结阳性的颈部中，11侧（73.3%）在放射性最高的淋巴结中发现了转移。切除放射性计数最高的前3个淋巴结可识别隐匿性转移疾病的患者。
切除放射性计数最高的前3个SLN可用于准确识别临床N0期喉癌或下咽癌患者颈部淋巴结转移情况。
