吲哚菁绿荧光在早期舌癌和口咽癌前哨淋巴结活检中的应用价值。
Application value of indocyanine green fluorescence in sentinel lymph node biopsy for early-stage tongue cancer and oropharyngeal cancer.
机构信息
Third Department of Head and Neck Surgery, Hunan Cancer Hospital; Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013.
Translational Medicine Center, Hunan Cancer Hospital; Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Dec 28;47(12):1683-1688. doi: 10.11817/j.issn.1672-7347.2022.220150.
OBJECTIVES
Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer.
METHODS
Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed.
RESULTS
SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively.
CONCLUSIONS
Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.
目的
隐匿性颈淋巴结转移是早期舌癌和口咽癌复发的最重要原因。颈前哨淋巴结（SLN）活检有助于识别这些转移。色素染料和放射性核素被用于标记 SLN，但它们都存在不足。本研究旨在探讨吲哚菁绿荧光成像在早期舌癌和口咽癌患者颈 SLN 活检中的应用及临床价值。
方法
回顾性分析 2021 年 4 月至 10 月在湖南省肿瘤医院接受手术治疗且使用吲哚菁绿作为示踪剂寻找 SLN 的 23 例早期舌癌和口咽癌患者。计算 SLN 的检出率，并分析 SLN 在颈部不同区域的分布。
结果
23 例患者中，22 例成功识别出 SLN，检出率为 95.65%。这 22 例患者中，3 例发现有癌转移，隐匿性淋巴结转移率为 13.63%。SLN 阴性患者未检出病理阳性淋巴结，因此阳性预测率为 100%。对于原发灶位于舌前 2/3 的患者，SLN 位于颈区 I、II、III、IV 的构成比分别为 15.15%、71.72%、13.13%、0；对于原发灶位于舌根的患者，SLN 位于颈区 I、II、III、IV 的构成比分别为 0、44.44%、44.44%、11.12%。
结论
吲哚菁绿荧光成像在早期舌癌和口咽癌患者前颈 SLN 活检中具有较高的检出率和准确的阳性预测值，同时还能反映不同原发部位肿瘤的淋巴引流，具有较高的临床价值。
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