cN0喉癌前哨淋巴结的检测及意义

Significance of sentinel lymph node detection for cN0 laryngeal carcinoma

目的应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结（SLN），并评价SLN对颈部淋巴结转移状况的预测价值。方法41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN。核素法为手术前于喉镜引导下在肿瘤周围注射^99Tc^n-硫胶体（SC）进行SLN显像，手术中用吖探针探测放射性“热点”；染料法为手术中注射亚甲蓝，示踪蓝染的SLN；联合法为将核素法和染料法联合应用的方法。结果核素法、染料法和联合法对SLN的检出率分别为87．8％、70．7％和92．7％（P〈0．01）；核素法与联合法、染料法与联合法检出SLN数目的差异有统计学意义（P〈0．05，P〈0．01），核素法与染料法检出SLN数目的差异无统计学意义（P〉0．05）。病理结果示，有9例患者淋巴结转移，占22．0％。联合法检测SLN的灵敏度、准确度和阴性预测值分别为88．9％、97．4％和96．7％。结论联合应用核素法和染料法可提高SLN检出的准确性，SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态。

Objective The purpose of this study was to investigate the clinical value of radiolabeled tracer method, methylene blue method and combination of these two methods in detection of sentinel lymph node （ SLN）, and to evaluate the accuracy of SLN in predicting the cervical lymph nodes status in laryngeal carcinoma patients with clinically negative neck lymph nodes （cN0）. Methods Forty-one patients with cN0 laryngeal neoplasms underwent SLN detection using both of radiolabeled tracer and methylene blue. SLN imaging was performed with laryngoscope-guided injection of radioactive isotope ^99Tcm-sulfur colloid （SC） into the laryngeal carcinoma before surgery, then all these patients underwent intraoperative lymphatic mapping with a handheld gamma-detecting probe. After mapping of SLN, methylene blue was subsequently injected at the same spots around the tumor in order to identify SLN during surgery. The results of SLN detection by isotope tracer, dye and combination of both methods were compared. Results The SLN detection rates by radiolabeled tracer, methylene blue and combined method were 87.8%, 70.7% and 92.7%, respectively （P 〈0.01）. The number of detected SLN was significantly different between radiolabeled tracer method and combined method （P 〈 0.05 ）, and also between blue dye method and combined method （P 〈 0. O1 ）. However, no statistically significant difference was found between methylene blue method and radiolabeled tracer method （ P 〉 0.05 ）. Nine patients were found to have lymph node metastasis by final pathological examination. The sensitivity, accuracy and negative predictive values of SLN detection by the combined method using radiolabeled tracer and methylene blue were 88.9%, 97.4% and 96.7%, respectively. Conclusion The combined method using radiolabeled tracer and methylene blue can improve the accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately predict the cervical lymph node status in cN0 laryngeal carcinoma.