胃癌前哨淋巴结术中定位和病理学检查

Localization and pathological examination of sentinel lymph node during operation in gastric cancer

目的探讨肿瘤前哨淋巴结(SLN)活检技术在胃癌诊疗中应用的可行性。方法将38例胃癌患者,按肿瘤浸润深度分组,用术中注射美蓝的方法定位前哨淋巴结,用细胞角蛋白(CK-19)免疫组织化学染色判断淋巴结转移情况。结果38例患者全部检出SLN(100%)。出现淋巴结转移的有18例,其中SLN出现转移的有15例。SLN预测淋巴结癌转移的敏感性、假阴性率和准确率分别为83.3%、16.7%和92.1%;胃癌T1组无SLN假阴性者,准确率100%;T2组有1例假阴性者,准确率94.1%;T3组假阴性2例,准确率6/8例。结论采用肿瘤周围注射亚甲蓝的方法术中定位淋巴结为可行的SLN术中定位方法。

Objective To evaluate the application of sentinel lymph node(SLN) biopsy in diagnosis and treatment of gastric cancer. Methods Thirty eight patients with gastric cancer were divided into three groups(T1,T2,T3) according to tumor invasion depth. SLN was localized using methyl blue injection method. Metastatic lymph nodes were detected by immunohistochemical staining of cytokeratin(CK 19). Results SLNs were detected in all 38 patients and lymph node metastasis occurred in 18 cases. The sensitivity,false negative rate,and diagnostic accuracy of SLN for lymph node metastasis were 83.3%,16.7%and 92.1%,respectively. The diagnostic accuracy was 100%in T1 cases without false negative cases,94.1%in T2 cases with one false negtive case,75%in T3 cases with two false negtive cases. Conclusion The method of injecting methylene blue around the primary tumor is a feasible method that can determine SLN localization during operation.