前哨淋巴结活检术应用于外阴癌的初步研究

An initial experience of the use of sentinel lymph node biopsy in squamous cell cancer of the vulva

目的探讨前哨淋巴结活检术（SLNB）应用于外阴癌的可行性。方法选择2004年10月q008年4月间于中国医学科学院肿瘤医院接受手术治疗、术中采用SLNB的外阴癌患者21例，其中处于研究前期（即2005年5月前）的11例患者采用染料法识别前哨淋巴结（SLN）、处于研究后期的10例患者采用核素-染料联合法识别SLN，术后行常规病理检查。以病理检查结果为金标准，观察SLNB的检测效果；并观察与SLNB相关的并发症的发生情况。结果21例患者中，20例（95％）检出SLN，其中8例为单侧腹股沟、12例为双侧腹股沟。20例SLN阳性患者共检出83枚SLN，每例患者平均检出4．2枚（1—9枚），每侧腹股沟平均2．6枚（1～6枚）。其中，染料法每例患者平均检出4．4枚、每侧腹股沟平均2．5枚，核素一染料联合法每例患者平均检出3．9枚、每侧腹股沟平均2．7枚，分别比较，差异均无统计学意义（t=0．459，P=0．652；t=-0．421，P=0．717）。20例SLN阳性患者腹股沟浅淋巴结中均检出SLN，其中1例双侧腹股沟深淋巴结中也检出SLN。20例SLN阳性的患者中，8例（10侧腹股沟）术后病理检查显示腹股沟淋巴结转移，其中7例患者（9侧腹股沟）的转移淋巴结中均包括有SLN、1例（1侧腹股沟）出现假阴性。以SLN识别预测同侧腹股沟淋巴结转移的假阴性率为10％（1／10），阴性预测值为96％（22／23）。未发现与SLNB相关的损伤及不良反应。结论SLNB应用于外阴癌安全、可行，以SLN预测同侧腹股沟淋巴结转移具有较高准确性。

Objective To evaluate the feasibility of sentinel lymph node biopsy （SLNB） in patients with vulvar cancer. Methods Twenty-one patients with vulvar squamous cancer undergoing radical surgery admitted in Cancer Hospital of Chinese Academy of Medical Sciences from Oct. 2004 to Apr. 2008, were enrolled in the study. SLNB procedure was performed with blue dye alone in the first eleven patients, while the later ten patients, a combination procedure with radioactive tracer and blue dye was used to detect sentinel lymph node （SLN）. All resected nodes were submitted to the pathological examination, which was considered as the gold standard to determine the efficacy of SLNB. The complications related to SLNB were also observed during the study. Results The sentinel node was identified in 20 patients （95%） , included 8 cases with unilateral SLN and 12 cases with bilateral SLN. A total of 83 SLN were identified with a mean number of 4. 2 per patient （ range, 1 - 9） or 2. 6 per groin （ range, 1 - 6）. Difference between the mean number of SLN （4.4 per patient, 2. 5 per groin） identified by blue dye or by combined procedure （3.9 per patient, 2. 7 per groin） was not statistically significant （ t = 0. 459, P = 0. 652 ; t = - 0. 421, P = 0. 717 ）. Twenty patients were detected to positively superficial inguinal SLN and one of them also positively bilateral deep femoral SLN, 8 （10 groins） of them were detected positively nodal metastases. Among of eight patients, 7 （9 groins）of them were detected more than one SLN involved, while 1 of them were detected false-negative node involved. The false negative rate of was 10% （ 1/10）, negative predictive value was 96% （22/23）. No complications were attributed to the study. Conclusions SLNB procedure in vulvar cancer is feasible and safe. SLN identification appears to be highly accurate for detecting metastases in the ipsilateral inguinal lymphatic basins.