前哨淋巴结检测在早期宫颈癌中的临床应用

Clinical Application of Sentinel Lymph Node Detection to Early Stage Cervical Cancer

背景与目的:前哨淋巴结(sentinellymphnode,SLN)检测已经广泛应用于一些实体肿瘤的治疗方案设计中,特别是乳腺癌和体表恶性黑色素瘤。若SLN阴性,则可视为该淋巴区域无肿瘤转移。本研究的目的是探讨放射性核素定位法、活性染料定位法及二者联合法探测宫颈癌SLN和评价SLN对早期宫颈癌盆腔淋巴结转移状况的预测价值。方法:27例欲行广泛性子宫切除+盆腔淋巴结清扫术的宫颈癌患者,术前16h注射99mTc-右旋糖酐,进行SLN显像;手术时,注射亚甲蓝约4ml,寻找蓝染淋巴结;同时术中用γ探针探测放射性热点。SLN全部被切除后,行广泛子宫切除+盆腔淋巴结清扫术,所有切除的SLN及非SLN(non-sentinellymphnode,NSLN)分别送常规病理检查。结果:染料法、核素法、联合法对27例患者的SLN检出率分别为96.3%(26/27)、100%(27/27)、100%(27/27);27例患者中染料法、核素法、联合法分别检出SLN61枚、69枚、70枚;核素法中,术前SPECT/CT融合显像较平面显像多检出4枚宫旁淋巴结。病理结果示7例患者有淋巴结转移,占25.9%(7/27)。SLN检测的敏感性、准确性、阴性预测值、假阴性率分别为85.7%(6/7),96.3%(26/27),95.2%(20/21),14.3%(1/7)。结论:术前SPECT/CT三维断层显像检出SLN的敏感性优于平面显像,并且能够对SLN进行准确定位;联合应用放射性核素定位法和活性染料识别法提高了SLN检出的准确性;SLN的病理结果可以准确的预测早期宫颈癌患者盆腔淋巴结的病理状态。

BACKGROUND ＆ OBJECTIVE： Sentinel lymph node （SLN） identification has been increasingly used in the treatment design of a variety of solid tumors, particularly breast cancer and melanoma. A negative SLN predicts the absence of tumor metastases in the regional lymph nodes with high accuracy. This study was to investigate the clinical value of combined isotope-dye technique for detecting SLN, and to evaluate the accuracy of SLN in predicting the pelvic lymph nodes status in patients with early stage cervical cancer. METHODS： A total of 27 patients with early stage cervical cancer,scheduled for radical hysterectomy and total pelvic lymphadenectomy, were eligible for the study. Lymphoscintigraphy was performed with injection of radioactivity isotope ^99mTc-labeled dextran （^99mTc-DX） into the uterine cervix 16 h before surgery. Methylthioninium （4 ml） was injected into the same points as ^99mTc-DX during surgery, and the patients underwent lymphatic mapping with a handheld gamma-detecting probe. After resection of SLNs, standard radical hysterectomy with pelvic lymph node dissection was performed. All removed lymph nodes, including the SLNs, were examined by routine histopathology. The histopathologic results of SLNs and non-SLNs were compared. RESULTS： The detection rates of SLN were 96.3% by blue dye method, and 100% by radiolabeled tracer or combined isotope-dye. Blue dye method identified 61 SLNs, radiolabeled tracer identified 69 SLNs, and combined isotope-dye identified 70 SLNs. Preoperative SPECT/CT fusion images detected 4 SLNs in the parametrium. Seven （25.9%） patients had lymph node metastasis. The sensitivity, accuracy, negative predictive value, and false negative rate of SLN detection were 85.7% （6/7）, 96.3% （26/27）, 95.2% （20/21）, and 14.3% （1/7）, respectively. CONCLUSIONS. SPECT/ CT imaging not only is superior to planar imaging in detecting SLN but also enables precise localization of SLNs. The combined isotope-dye method can improve the accuracy of SLN detection. SLN detection can accurately predict the pelvic lymph nodes status in early stage cervical cancer.