非小细胞肺癌前哨淋巴结扫描活检术的临床研究

Clinical study on sentinel lymph node dissection in non-small cell lung cancer

目的探索非小细胞肺癌(NSCLC)根治术中前哨淋巴结(SLN)检测的可行性。方法选择24例可切除的非小细胞肺癌患者。手术切除SLN,并行系统的肺门、纵膈淋巴结清扫术。所有切除的淋巴结送常规HE染色检查,联合免疫组化角蛋白染色方法检测是否有微转移。结果 24例NSCLC患者的SLN检出率为100%,共找到SLN 50个,非前哨淋巴结(NSLN)143个,HE检测发现50个SLN中有31个癌转移,143个NSLN中有27个癌转移。前哨淋巴结活检(SLNB)和根治性纵膈淋巴清扫术切除阳性淋巴结的可能性分别为62%和30.1%。CK-19作为单抗进行免疫组化检测,发现常规HE染色SLN阴性患者的4枚前哨淋巴结2枚有转移,从而使SLNB预测区域淋巴结状态的敏感性从95.45%提高到100%;准确率从95.83%提高到100%;假阴性率从4.55%降为0%。最常见SLN发生站点为第11站,随后是第12站、纵膈淋巴结(5、6)、第10站。结论 SLN可以用于预测NSCLC肺门纵隔淋巴结是否转移。

Objective To explore the feasibility of sentinel lymph node （SLN） detection in the radical resection of non-small cell lung cancer （NSCLC）.Methods Twenty-four patients with resectable NSCLC were selected.SLN was removed by operation,and systemic hilum of the lung and mediastinal lymphadenectomy were performed.All removed lymph nodes were given routine HE staining examination.Immunohistochemistry keratin staining method was combined to detect whether there was a micrometastasis.Results The SLN detection rate in 24 patients was 100％,with a total of 50 SLN,and 143 non-sentinel lymph nodes （NSLN） were found.HE staining demonstrated that cancer metastasis occurred to both 31 out of the 50 SLN and 27 out of the 143 NSLN.The probabilities of sentinel lymph node biopsy （SLNB） and positive lymph nodes removed by radical mediastinal lymph node dissection were 62％ and 30.1％,respectively.As a monoclonal antibody,CK-19 was detected by immunohistochemistry.It was found through CK-19 that the metastasis occurred in 2 out of 4 SLN patients with negative SLN stained with routine HE,which improved the sensitivity of lymph node status in SLNB predictive region from 95.45％ to 100％ and accuracy rate from 95.83％ to 100％,whereas it decreased the false negative rate from 4.55％ to 0％.The 1 1th site was the most common occurrence site of SLN,then the 12th site,mediastinal lymph nodes （5 and 6） and 10th site.Conclusion SLN can be used to predict whether the metastasis occurs in the hilum of the lung and mediastinal lymph nodes in NSCLC.