前哨淋巴结活检在甲状腺乳头状癌的临床应用

Sentinel lymph node biopsy in papillary thyroid cancer

目的探讨前哨淋巴结（sentinel lymphnode，SLN）活检术在甲状腺乳头状癌中应用的准确性及可行性。方法19例45岁以上临床淋巴结阴性（cN0）的甲状腺乳头状癌患者，术中在肿瘤周围4点注射2％美蓝，获取染色淋巴结，再行肿瘤侧甲状腺腺叶、峡部切除、对侧次全切除及改良式颈部淋巴结清扫。所有淋巴结分区送常规病理检查。结果19例中，18例显示了SLN，平均每例2．5枚，13例SLN阳性，1例非SLN阳性，1例未检出SLN发现有淋巴结转移。SLN活检的灵敏度为86．6％，准确度为94．4％，阴性预测值为80％，阳性预测值为100％。结论SLN活检能准确预测颈部淋巴结状态，对cN0甲状腺乳头状癌的手术治疗方案有重要指导意义。

Objective To investigate the reliability and feasibility of sentinel lymph node biopsy （SL- NB） in papillary thyroid carcinoma （PTC） using methylene blue staining techniques. Methods Nineteen patients, older than 45, with PTC were included in the study. No case had clinical evidence of cervical lymph node involvement（cN0）. Methylene blue was injected around the tumor during surgery. The stained lymph nodes were dissected. Subtotal thyroidectomy and modified radical neck dissection were performed. Both the bulk specimen and SLN were submitted for routine histology. Results The sentinel lymph nodes（SLN） were identified in 18 cases, with SLN positive in 13 cases. The sensitivity and specificity of SLNB were 86. 6% and 94. 4% respectively. There was 1 case with SLN metastasis in the lateral neck, and 1 case with positive lymph node and negative SLN. Conclusion SLNB is sensitive in detecting cervical lymph node metastasis and has clinical significance in making operative plans for cN0 PTC.