联合纳米炭和^(99m)Tc-硫胶体标记法行直肠癌前哨淋巴结活检的研究

Study on sentinel lymph node biopsy by carbon nanoparticles and ^(99m)Tc sulfur colloid for rectal cancer

目的探讨联合应用纳米炭(carbon nanoparticles,CNP)和99mTc-硫胶体(99mTcsulfurcolloid,TSC)标记法行直肠癌前哨淋巴结(sentinel lymph node,SLN)活检的可行性。方法对复旦大学附属中山医院普外科2004年10月至2006年9月,28例直肠癌病人术中分别于肿瘤周围浆膜下(10例)或黏膜下(18例)注射CNP和TSC以标记区域淋巴结,进行SLN活检。对HE染色检测阴性的SLN则加行细胞角蛋白20免疫组化检测(Cytokratin20-ImmunohistochemistryCK20-IHC)。结果28例直肠癌病人中,SLN的检出率为96%,共检出SLN52枚,平均2枚。HE染色检测SLN的准确度为92.59%,假阴性率为10%。18例常规HE染色检测SLN和非SLN均阴性病人中,加行SLN的CK20?IHC检测,5例阳性。结论联合CNP和TSC对直肠癌的SLN定位活检是可行的,应依据肿瘤部位的不同分别选用黏膜下或浆膜下注射CNP和TSC。

Objective To evaluate the feasibility of sentinel lymph node （SLN） biopsy （SLNB） after carbon nanoparticles （CNP） and 99m^Tc sulfur colloid （TSC） injected in rectal cancer patients. Methods Twenty-eight patients underwent radical resection of a primary rectal cancer between October 2004 and September 2006 at Zhongshan Hospital of Fudan University were considered for inclusion. During resection, SLN mapping was performed with CNP and TSC. All lymph nodes were stained with HE. SLNs with negative routine HE staining were further analyzed with cytokratin 20 immunohistochemistical （CK20-IHC）staining. Results Fifty-two nodes （ 2 per patient） were identified as SLNs in 27 of 28 patients. In 18 of 27 patients, with SLNs and nonSLNs proven negative by HE staining, 5 patients showed positive SLNS by CK20-IHC. The accuracy rating and the false-negative rate of HE staining for SLN were 92.59% and 10% respectively. Conclusion SLNB by CNP and TSC for rectal cancer is feasible. Rectal cancer SLNB should apply different mapping method based on the lesion position.