甲状腺癌前哨淋巴结活检的应用观察研究

The study on application of biopsy of sentinel lymph node in thyroid cancer

目的应用SLNB技术检测甲状腺癌前哨淋巴结,评价染料核素联合定位法的可行性及临床应用情况。方法应用SLNB技术检测在我科住院的46例甲状腺癌患者的前哨淋巴结,男11例,女35例;年龄25～75岁。Ⅰ期21例,Ⅱ期17例,Ⅲ期6例,Ⅳ期2例;有淋巴结转移31例,无淋巴结转移15例;甲状腺乳头状癌28例,滤泡腺癌17例,髓样癌1例。结果 46例甲状腺癌有43例检出SLN,其中SLN共检出65枚,其中1枚的23例,取出2枚的18例,取出3枚的2例。术中行冰冻检出有转移的SLN28枚,术后常规病理检出有转移的SLN31枚。SLN检出率93.4%(43/46),敏感性90.3%(28/31),假阴性率9.7%(3/31)。结论用核素、染料、r计数仪联合检测SLN,检出率较高(93.4%,43/46),敏感性也较高(90.3%,28/31),假阴性率9.7%(3/31)。与国内外报道接近,分别为66%～100%和80%～100%。因此用核素、染料、r计数仪联合检测SLN的方法可靠、准确性高,可以作为常规方法检测SLN。而根据SLN的结果决定是否行颈淋巴结清扫术,将有可能取代传统的颈淋巴结清扫原则。

Objective To use sentinel lymph node biopsy（SLNB） for detecting sentinel lymph node in thyroid cancer in order to evaluate the feasibility and clinical application of the method of location by combination of dye and nuclide.Methods SLNB was used to examine sentinel lymph node in 46 patients with thyroid cancer who hospitalized in our department from January 1987 to December 2007.Of these 46 cases,11 were males and 35 were females,aged from twenty-five to seventy-five years;21 cases were at the first stage,17 at the second stage,6 at the third stage and 2 at the fourth stage according to standard for Middle-aged Staging;31 cases had lymph node metastasis,15 without lymph node metastasis;28 cases were papillary thyroid cancer,17 were follicular adenocarcinoma and one was medullary carcinoma.Results SLN were found in 43 of the 46 cases of thyroid cancer.A total of 65 SLN were detected.Of these cases,23 had one SLN,18 had two SLN and two had three SLN.Intraoperative frozen section examination detected 28 SLN with tumor metastasis and routine post-operative pathological examination detected 31 SLN with tumor metastasis.SLN detection rate was 93.4%（43/46）,sensitivity was 90.3%（28/31）and false negative rate was 9.7%（3/31）.Conclusion The detection rate of SLN by combination of radionuclide,dyes and γ Counter was high,attaining 93.4%（43/46）,the sensitivity was also high,attaining 90.3%,and false negative rate was 9.7%.The results were close to those reported in domestic and international literature,i.e.66%-100% and 80%-100% respectively.Combination of radionuclide,dyes and γ counter for detecting SLN is reliable and the accuracy is high,and could be used as a routine method for detecting SLN.According to the results of detecting SLN,it can be decided whether dissection of neck lymph nodes is needed.It is possible that this method may replace the traditional principles of neck lymph node dissection.