Portugal L G, Wilson K M, Biddinger P W, Gluckman J L
Department of Otolaryngology-Head and Neck Surgery, University of Illinois College of Medicine at Chicago, USA.
Arch Otolaryngol Head Neck Surg. 1996 May;122(5):517-9. doi: 10.1001/archotol.1996.01890170051010.
To determine the efficacy of toluidine blue in assessing margin status after removal of squamous cell carcinomas of the upper aerodigestive tract.
A prospective study of 50 consecutive patients undergoing surgical resection of squamous cell carcinomas of the upper aerodigestive tract was performed during February 1 to December 1, 1993. After tumor resection, toluidine blue was applied directly to the remaining unresected mucosa. The staining characteristics of the mucosa were then compared with those of frozen-section biopsy specimens of the margins and with the permanent histologic findings of the resected tumor specimen.
In three cases, toluidine blue identified a positive margin, which was confirmed on frozen and permanent section. In six cases, false-positive staining was noted, which was most frequently related to traumatic handling of the mucosa during the resection. In no case was a positive margin found on histologic staining that failed to stain with toluidine blue. During routine staining of surrounding unresected mucosa, three cases of a second primary tumor that was not seen on routine evaluation before tumor removal were identified with toluidine blue. In one case, a second T1 oral cavity lesion was found, while in the other cases, separate pharyngeal lesions were identified.
Based on these findings, it appears that toluidine blue improved the ability to assess margin status at the time of resection, and we advocate its use after resection of tumors to the upper aerodigestive tract.
确定甲苯胺蓝在上呼吸道消化道鳞状细胞癌切除术后评估切缘状态的有效性。
1993年2月1日至12月1日对50例连续接受上呼吸道消化道鳞状细胞癌手术切除的患者进行了一项前瞻性研究。肿瘤切除后，将甲苯胺蓝直接应用于剩余的未切除黏膜。然后将黏膜的染色特征与切缘冰冻切片活检标本以及切除肿瘤标本的永久组织学结果进行比较。
3例中，甲苯胺蓝确定切缘阳性，冰冻切片和永久切片均证实。6例出现假阳性染色，最常见于切除过程中对黏膜的创伤性处理。在任何情况下，组织学染色呈阳性而甲苯胺蓝未染色的切缘均未被发现。在对周围未切除黏膜进行常规染色时，甲苯胺蓝发现了3例在肿瘤切除前常规评估中未发现的第二原发性肿瘤。1例中发现了第二个T1期口腔病变，其他病例中发现了单独的咽部病变。
基于这些发现，甲苯胺蓝似乎提高了切除时评估切缘状态的能力，我们提倡在上呼吸道消化道肿瘤切除后使用它。
