前哨淋巴结活检在无临床淋巴结转移的早期舌癌临床治疗中的应用价值

Application value of sentinel node biopsy in early stage oral tongue cancer with clinically negative neck

目的探讨前哨淋巴结活检技术用于指导无临床淋巴结转移的早期舌癌颈部处理方案的可靠性。方法对18例临床淋巴结阴性（cN0期）的T1和他期口腔舌鳞状细胞癌患者，采用核素法（淋巴结闪烁显像法＋1探针法）定位前哨淋巴结，进行术中冰冻病理检查，患侧颈部常规行I-Ⅲ区或I～Ⅳ区清扫，将淋巴结清扫病理和免疫组化结果与前哨淋巴结冰冻结果进行对比。比较前哨淋巴结活检与原发灶浸润深度两种方法预测颈部淋巴结转移情况的准确性。结果18例患者全部检出前哨淋巴结，检出率为100％。前哨淋巴结分布于Ib区6枚，Ⅱa区22枚，Ⅲ区2枚。18例患者中，有4例患者冰冻病理显示前哨淋巴结阳性。18例患者前哨淋巴结冰冻病理结果与术后颈部淋巴结常规病理结果相符，灵敏度和特异度均为100％。与以原发灶浸润深度〉4．0min为标准的方法（特异度为36．4％）比较，前哨淋巴结活检明显提高了预测的特异度。结论前哨淋巴结活检在早期舌癌的临床治疗中具有较好的实际应用价值。

Objective To evaluate the liability of sentinel node biopsy in the treatment of early stage oral tongue carcinoma with clinically negative neck. Methods Eighteen patients with T1 or T2 oral tongue carcinoma were enrolled in the prospective study. Preoperative lymphoscintigraphy and intra-operative hand-held gamma probe techniques were used to detect the sentinel lymph nodes. The sentinel lymph node biopsies were sent to frozen section pathology and the results were compared with specimen of routine selective neck dissection （ I -III or I - IV）. The accuracy of cervical metastasis prediction was compared between sentinel node biopsy and tumor thickness. Results Sentinel lymph nodes were identified in all 18 cases. The numbers of sentinel lymph nodes of level I b, II a and III were 6, 22 and 2, respectively. In this series, positive sentinel lymph nodes were revealed in 4 cases, which were also positive in the postoperative routine histology. In other cases, both sentinel lymph nodes and routine histology were negative. Both the sensitivity and specificity were 100%. Sentinel lymph node biopsy obviously improved the specificity of predicting cervical metastasis comparing with the tumor thickness. （ 100% vs. 36. 4% ）. Conclusion Sentinel node biopsy is effective and reliable in the treatment of early stage oral tongue cancer, and deserves clinical application.