de Hullu J A, Doting E, Piers D A, Hollema H, Aalders J G, Koops H S, Boonstra H, van der Zee A G
Department of Gynecology, Groningen University Hospital, The Netherlands.
J Nucl Med. 1998 Aug;39(8):1381-5.
In patients with early-stage squamous cell cancer of the vulva, inguinofemoral lymphadenectomy is performed primarily as a diagnostic procedure. The morbidity of this procedure, however, is not negligible. The aim of this study was to evaluate the feasibility of minimally invasive detection of the sentinel inguinofemoral lymph node (SILN) and to investigate whether the histopathology of the SILNs is representative of that of the other non-SILNs.
Patients with early-stage squamous cell cancer of the vulva, planned for resection of the primary tumor and uni- or bilateral inguinofemoral lymphadenectomy, were eligible for the study. Technetium-99m-labeled nanocolloid was injected intradermally at four locations around the tumor the day before operation. Images were recorded immediately and after 2.5 hr using a gamma camera. SILN locations were marked on the overlying groin skin. The next day, during general anesthesia, blue patent dye was injected intradermally at the same locations around the tumor. During the operation SILNs were identified at the place indicated using a handheld gamma-detection probe. It was noted if SILNs were found by the probe, by blue dye or by both techniques. After resection of the SILNs, a standard inguinofemoral lymphadenectomy was performed. The results of histopathology of the SILNs were compared with those of the non-SILNs.
The procedure was well tolerated by 10 of 11 patients. One patient, initially agreeing to participate, refused the injection of tracer because of fear of pain. In all 10 patients, identification of the SILNs was successful. The mean time for identification was 11 min. Identification of SILNs was primarily performed using the hand probe in all patients, whereas in 10 of 18 removed SILNs afferent lymph channels were also blue stained (56%). In 8 patients, pathologic examination showed no metastatic disease in both SILNs and non-SILNs, whereas in 2 patients metastases in the SILNs (one and two metastatic lymph nodes, respectively), as well as in other non-SILNs, were found.
This study shows that identification of SILNs in squamous cell cancer of the vulva is feasible with preoperatively administered 99mTc-labeled nanocolloid. Intraoperatively administered blue dye was only useful for confirmation of identification with nanocolloid. To date, no false-negative SILNs have been found, but expansion of the study is necessary to determine the possible clinical application of this new diagnostic technique.
在外阴早期鳞状细胞癌患者中，腹股沟股淋巴结切除术主要作为一种诊断性手术。然而，该手术的发病率不可忽视。本研究的目的是评估微创检测前哨腹股沟股淋巴结（SILN）的可行性，并研究SILN的组织病理学是否代表其他非SILN的组织病理学。
计划切除原发肿瘤并进行单侧或双侧腹股沟股淋巴结切除术的早期外阴鳞状细胞癌患者符合本研究条件。术前一天在肿瘤周围四个部位皮内注射99m锝标记的纳米胶体。立即以及2.5小时后使用γ相机记录图像。在腹股沟上方皮肤标记SILN的位置。第二天，在全身麻醉期间，在肿瘤周围相同部位皮内注射蓝色专利染料。手术过程中使用手持式γ检测探头在指示位置识别SILN。记录SILN是通过探头、蓝色染料还是两种技术发现的。切除SILN后，进行标准的腹股沟股淋巴结切除术。将SILN的组织病理学结果与非SILN的结果进行比较。
11例患者中有10例对该手术耐受性良好。1例最初同意参与的患者因害怕疼痛拒绝注射示踪剂。在所有10例患者中，SILN的识别均成功。识别的平均时间为11分钟。所有患者主要使用手持探头识别SILN，而在切除的18个SILN中，有10个的输入淋巴管也被蓝色染色（56%）。8例患者的病理检查显示SILN和非SILN均无转移性疾病，而2例患者的SILN（分别有1个和2个转移性淋巴结）以及其他非SILN中发现了转移。
本研究表明，术前给予99mTc标记的纳米胶体可在外阴鳞状细胞癌中识别SILN。术中给予的蓝色染料仅用于确认纳米胶体识别结果。迄今为止，尚未发现假阴性的SILN，但有必要扩大研究以确定这种新诊断技术的可能临床应用。
