[亚甲蓝法和放射性标记示踪剂法对喉癌和下咽癌颈部临床阴性患者前哨淋巴结检测的临床价值]

[The clinical value of sentinel lymph node detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck by methylene blue method and radiolabeled tracer method].

作者信息

Zhao Xin, Xiao Dajiang, Ni Jianming, Zhu Guochen, Yuan Yuan, Xu Ting, Zhang Yongsheng

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Nov;28(21):1652-4.

Abstract

OBJECTIVE

To investigate the clinical value of sentinel lymph node (SLN) detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck (cN0) by methylene blue method, radiolabeled tracer method and combination of these two methods.

METHOD

Thirty-three patients with cN0 laryngeal carcinoma and six patients with cN0 hypopharyngeal carcinoma underwent SLN detection using both of methylene blue and radiolabeled tracer method. All these patients were accepted received the injection of radioactive isotope 99 Tc(m)-sulfur colloid (SC) and methylene blue into the carcinoma before surgery, then all these patients underwent intraopertive lymphatic mapping with a handheld gamma-detecting probe and blue-dyed SLN. After the mapping of SLN, selected neck dissections and tumor resections were peformed. The results of SLN detection by radiolabeled tracer, dye and combination of both methods were compared.

RESULT

The detection rate of SLN by radiolabeled tracer, methylene blue and combined method were 89.7%, 79.5%, 92.3% respectively. The number of detected SLN was significantly different between radiolabeled tracer method and combined method, and also between methylene blue method and combined method. The detection rate of methylene blue and radiolabeled tracer method were significantly different from combined method (P < 0.05). Nine patients were found to have lymph node metastasis by final pathological examination. The accuracy and negative rate of SLN detection of the combined method were 97.2% and 11.1%.

CONCLUSION

The combined method using radiolabeled tracer and methylene blue can improve the detection rate and accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately represent the cervical lymph node status in cN0 laryngeal and hypopharyngeal carcinoma.

摘要

目的

通过亚甲蓝法、放射性示踪剂法以及这两种方法联合使用，探讨前哨淋巴结（SLN）检测在临床颈部阴性（cN0）喉癌和下咽癌患者中的临床价值。

方法

33例cN0喉癌患者和6例cN0下咽癌患者采用亚甲蓝法和放射性示踪剂法联合进行SLN检测。所有这些患者在手术前均接受了放射性同位素99锝（m）-硫胶体（SC）和亚甲蓝注射入癌灶，然后所有患者使用手持式γ探测仪和蓝色染色的SLN进行术中淋巴绘图。在绘制SLN后，进行了选择性颈清扫术和肿瘤切除术。比较放射性示踪剂、染料以及两种方法联合使用对SLN的检测结果。

结果

放射性示踪剂、亚甲蓝和联合方法对SLN的检测率分别为89.7%、79.5%、92.3%。放射性示踪剂法与联合方法之间以及亚甲蓝法与联合方法之间检测到的SLN数量有显著差异。亚甲蓝法和放射性示踪剂法的检测率与联合方法有显著差异（P<0.05）。最终病理检查发现9例患者有淋巴结转移。联合方法对SLN检测的准确率和阴性率分别为97.2%和11.1%。