专利蓝示踪胃癌前哨淋巴结及其微转移检测

Patent blue violet-directed mapping and micrometastasis detection of sentinel lymph node in gastric cancer

目的探讨专利蓝示踪法检测胃癌前哨淋巴结(sentinel lymph node,SLN)的可行性和临床意义。方法34例胃癌术中病灶周围浆膜或黏膜下注入专利蓝溶液,将首先染色的淋巴结视为SLN,并进行常规病理检查和淋巴结微转移(lymphnode micro metastasis,LNMM)检测。结果胃癌SLN检测成功率为94.1%(32/34),SLN检出个数平均为1.8个/例,SLN转移率明显高于非SLN(55.1%vs14.1%),由SLN诊断胃癌区域淋巴结转移情况的准确性为93.7%(30/32),假阴性率为8.3%(2/24),2例胃癌病例因SLN的LNMM检测阳性而使病理分期上调。结论专利蓝示踪检测胃癌SLN可准确预测胃癌区域淋巴结的转移情况,并使部分胃癌淋巴结的病理分期上调。

Objective： To investigate the feasibility and clinical significance of using patent blue violet-directed mapping for sentinel lymph node（SLN） detection in gastric cancer. Methods： Thirty four patients with gastric cancer, who underwent standard radical gastrectomy with lymphadenectomy （D2 or D3）, were enrolled in this study. Before resection, patent blue violet was intraoperatively injected into subserosal or submucosal layer adjacent to the tumor. Blue stained nodes were defined as SI.Ns and analyzed by routine HE preparations. Those negative SLNs were examined with cytokeratin immunohistochemical staining. The incidence of metastasis in SI.Ns was compared with that in non-SI.Ns. The diagnostic accuracy and false negative rate of regional lymph node status on the basis of SI.N status were calculated, respectively. Results：SLNs were detected in 32 of 34 patients with a success rate of 94.1 G. The number of SI.Ns ranged from 1 to 3 in one case, with a mean value of 1.8 per case. The incidence of metastasis was significantly higher in SI.Ns than that in non-SLNs （55. 1% vs 14. 1% ）. The diagnostic accuracy and false negative rate were 93.7% and 8.3%, respectively. Focused analysis of SI.N upstaged 2 cases of patients with gastric cancer. Conelusions：Patent blue violet-directed mapping of SLN in gastric cancer is technically feasible and may provide an accurate diagnostic procedure for detecting lymph node metastasis in patients with gastric cancer. Focused analysis of SLN may upstage gastric cancer.