非小细胞肺癌前哨淋巴结扫描活检术的临床研究

Clinical Research on The Technique of Sentinel Lymph Node Biopsy in Patients with NSCLC

目的 :探讨前哨淋巴结 (sentinellymphnode ,SLN)活检术在非小细胞肺癌 (non smallcelllungcancer ,NSCLC)诊断与分期中的作用和应用可行性。方法 :研究对象共 12例 (男性 2例 ,女性 10例 ,平均年龄 6 8.4岁 ) ,临床肿瘤分期为I～II期。术中将放射性示踪剂99锝硫胶体 (99Tcmsulfurcolloid ,99TcmSC ) 2ml分别等量注射于肿瘤边缘 4个象限 ,总剂量 2mCi。运用手持式γ射线探测扫描仪对研究对象的SLN进行探测扫描并摘取 ,然后均常规行肺门、纵隔淋巴结清扫术 ,标本送常规HE染色病理及免疫组化检查。结果 :12例中均检出SLN ,共 19枚 ;阳性 7例 ,11枚 ,阳性检出率 5 8.3% ,假阴性率 2 0 %。结论 :SLN活检术在寻找早期转移可能淋巴结方面具有较大临床价值。

Objective: To evaluate the role of the sentinel lymph node (SLN) biopsy in the diagnosis and staging for patients with non-small cell lung cancer (NSCLC). Methods: The study was carried out on 12 patients (M/F/2/10, mean age 68.4 years) with resectable NSCLC (Stage Ⅰ-Ⅱ). An injection of 2ml 99Tcm sulfur colloid was given intraoperatively in the 4 quadrants of the periphery of the tumor respectively, with a total dose of 2 mCi. After injections, all SLNs were detected and obtained with a hand-held gamma counter. And then a systematic mediastinal and hilar lymph nodal dissection were performed on each patient. The findings of operation were subjected to conventional HE and immunohistological analysis. Results: SLNs were detected in all 12 patients with a total number of 19 lymph nodes. 11/19 of the SLNs were found positive for metastatic involvement, and 7/12(58.3%) patients were found positive SLNs. 1/5(20%) of the patients with negative SLNs were found with one positive lymph node in the non-SLN area. Conclusion:The technique of SLN biopsy is a satisfying clinical procedure in detecting lymph nodes involved with early metastases in patients with NSCLC.