纳米炭定位前哨淋巴结在cN0甲状腺乳头状癌中的临床研究

Clinical Research of Carbon Nanoparticles in Sentinel Lymph Nodes Orientation of cN0 Thyroid Papillary Carcinoma

目的应用纳米炭注射的方法标记cN0甲状腺乳头状癌前哨淋巴结,评价纳米炭定位前哨淋巴结的可行性及临床价值。方法应用纳米炭对48例甲状腺乳头状癌患者行前哨淋巴结定位活检,并常规行患侧功能性颈淋巴结清扫术,将前哨淋巴结及清扫的颈淋巴结分别送检,记录两者的位置及数目并比较两者的病理学状况,分析前哨淋巴结分布区域及甲状腺癌淋巴转移特点。结果 48例甲状腺乳头状癌患者中有45例显示了前哨淋巴结,平均每例2.58枚,21例为阳性,其检出率、准确率、敏感性、假阴性率分别为93.75%、93.33%、87.50%、12.50%,前哨淋巴结检出率在IV区和VI区最多,阳性率在IV区和VI区最高(P<0.05)。结论纳米炭作为一种新型的淋巴示踪剂,具有淋巴染色特异性高、染色快、持续时间长、不易引起甲状旁腺染色的优势,能准确反应甲状腺乳头状癌淋巴转移情况,是甲状腺前哨淋巴结活检较可靠的示踪剂,对cN0甲状腺乳头状癌的颈淋巴清扫范围及清扫的彻底性具有重要的临床指导价值。

Objective Apply the method of carbon nanoparticles injection to label the sentinel lymph nodes in cN0 thyroid papillary carcinoma,and to evaluate the practicability and clinical value of carbon nanoparticles in the use of orientation of sentinel lymph nodes.Methods 48 thyroid papillary carcinoma patients were given sentinel lymph nodes biopsy with carbon nanoparticles,ipsilateral functional cervix lymph node dissection simultaneously.Pathology examine of the sentinel lymph nodes were made and dissected cervix lymph node respectively,the sentinel lymph nodes locations and amounts were recorded,the two pathology results wre compared,the sentinel lymph nodes distributing area and the characteristics of lymphatic metastasis in thyroid papillary carcinoma were analysed.Results In 48 thyroid papillary carcinoma patients,45 patients sentinel lymph nodes detected,2.58 in average of every patient,21 patients positive in lymph nodes.The relevance ratio is 93.75%,the specificity and sensibility is 93.33% and 87.50% respectively,and the false negative rate is 12.50%.The relevance ratio of sentinel lymph nodes is the highest in region Ⅳ and VI,the positive rate is the highest in region Ⅳ and VI（P0.05）.Conclusion Carbon nanoparticles,as a new tracer for lymph nodes,has high specificity,dyeing fast and long duration characters for labeling lymph nodes,which could reflect lymphatic metastasis in thyroid carcinoma accurately,but parathyroid gland stained seldom.It is an ideal and reliable tracer in sentinel lymph nodes biopsy,that is of great clinical importance in the region of cervix lymph node thorough dissection in cN0 thyroid papillary carcinoma.