前哨淋巴结检测在胃癌诊断中的作用

The Clinical Value of Sentinel Lymph Node Biopsy in Gastric Cancer

目的探讨胃癌前哨淋巴结检测(SLNB)的临床价值。方法使用亚甲蓝对40例胃癌患者行前哨淋巴结术中标识活检,随后行D2或D2以上手术。结果本组病例SLN预测胃周淋巴结转移的敏感性为91.67%(22/24),假阴性率为8.83%(2/24),准确率为94.87%(37/39)。SLN在第1站占87.18%(34/39);检出率依次:No3、No4、No5、No6等。SLN在第2站占12.82%(5/39);检出率依次:No7、No8等。同时,SLN预测胃周淋巴结转移的敏感性和准确率随胃癌浸润深度的增加而降低,T1期敏感性和准确率为100%,T3期的敏感性为84.62%(11/13),准确率88.23%(15/17)。22例转移的SLN中,3例SLN为唯一转移部位,且均为T1、T2期。结论SLNB符合胃癌的一般淋巴结转移规律和"跳跃性转移"特点,能准确反映胃癌的淋巴结转移状况,更适于早期胃癌的检测;可能提高胃癌淋巴结微转移的检出率和胃癌分期的准确性及有望指导胃癌淋巴结清扫具有临床价值。

Objective To investigate the clinical value of sentinel lymph node biopsy （SLNB） in gastric cancer. Methods Forty patients with gastric cancer intraoperatively underwent lymphatic mapping and SLNB with methylene blue. Resuits The sensitivity of SLN status in the diagnosis of the lymph node metastasis status of the patients was 91.67% （22/24）, false negative rate was 8. 83% （2/24） and accuracy was 94. 87% （37/39）. SLN was identified in the first station lymph nodes for 34 （87.18%） of the 39 cases and the second station for other 5 （ 12. 82% ） cases. The sensitivity and accuracy of SLN status lowered with the increasing invasion depth of gastric cancer. In T1 group, the sensitivity and accuracy was 100%, 100%. In T3 group, the sensitivity and accuracy was 84. 62% （11/13）, 88. 23% （15/17）. 22 patients were found to have lymph node metastasis in SLNs, 3 in SLNs alone. Conclusion SLNB accurately predict the lymph node metastasis status, improve the efficiency of detection of hymph node micrometastasis, improve accuracy rate of staging and guide lymphadenectomy in gastric cancer.