胸腔镜荧光成像系统和分子检测在非小细胞肺癌中的前哨淋巴结导航手术。
Sentinel node navigation surgery by thoracoscopic fluorescence imaging system and molecular examination in non-small cell lung cancer.
机构信息
Department of Surgery II, Faculty of Medicine, Oita University, Oita, Japan.
出版信息
Ann Surg Oncol. 2012 Mar;19(3):728-33. doi: 10.1245/s10434-011-2145-x. Epub 2011 Nov 19.
PURPOSE
The application of sentinel node navigation surgery in non-small cell lung cancer (NSCLC) is not popular because of the difficulty of sentinel node identification and the low incidence of complications after systemic lymph node dissection. We report the intraoperative assessment of sentinel node metastasis by thoracoscopic ICG fluorescence imaging system and real-time reverse transcription-polymerase chain reaction (RT-PCR).
METHODS
Sixty-one patients who underwent surgery between January 2009 and December 2010 were investigated for sentinel node biopsy. ICG fluorescence imaging was applied by an infrared light CCD system, and sentinel nodes were identified and dissected. Intraoperative real-time quantitative RT-PCR to determine the expression of cytokeratin 19 (CK-19) was performed for evaluation of metastasis and finally histologic examination of hematoxylin and eosin-stained, paraffin-embedded sections.
RESULTS
Sixteen (80%) of 20 patients with segmentectomy and 33 (80.5%) of 41 with lobectomy were identified for sentinel lymph nodes. The total identification rate was 80.3% (49 of 61). The false-negative rate was 2.1% (1 of 49). The overall accuracy rate was 78.7% (48 of 61 patients). Disease of four of these patients was upstaged to stage IIA by RT-PCR for CK-19 expression, which was positive for sentinel nodes and micrometastases.
CONCLUSIONS
These results demonstrated that thoracoscopic ICG fluorescence imaging-guided surgery and real-time quantitative RT-PCR were useful for sentinel node biopsy and might be a powerful tool for more focused pathologic or molecular evaluation for staging.
目的
由于前哨淋巴结（SLN）识别困难和全身淋巴结清扫术后并发症发生率低，前哨淋巴结导航手术在非小细胞肺癌（NSCLC）中的应用并不广泛。我们报告了使用胸腔镜吲哚菁绿荧光成像系统和实时逆转录聚合酶链反应（RT-PCR）对 SLN 转移进行术中评估。
方法
我们对 2009 年 1 月至 2010 年 12 月期间接受手术的 61 例患者进行了前哨淋巴结活检调查。采用红外光 CCD 系统进行 ICG 荧光成像，识别和解剖 SLN。进行术中实时定量 RT-PCR 以确定细胞角蛋白 19（CK-19）的表达，以评估转移情况，并最终进行苏木精和伊红染色、石蜡包埋切片的组织学检查。
结果
20 例节段切除术患者中有 16 例（80%）和 41 例肺叶切除术患者中有 33 例（80.5%）被识别出 SLN。总的识别率为 80.3%（61 例中有 49 例）。假阴性率为 2.1%（49 例中有 1 例）。总的准确率为 78.7%（61 例中有 48 例）。通过 RT-PCR 检测 CK-19 表达，其中 4 例患者的疾病分期上调至 IIA 期，SLN 和微转移均呈阳性。
结论
这些结果表明，胸腔镜吲哚菁绿荧光成像引导手术和实时定量 RT-PCR 可用于 SLN 活检，可能是进行更有针对性的病理或分子分期评估的有力工具。
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