纤支镜注射同位素示踪剂在非小细胞肺癌前哨淋巴结的初步探讨

Preliminary study of bronchoscopic radioisotope injection technique for detecting sentinel lymph node of non-small cell lung cancer

目的：前瞻性研究纤支镜注射示踪剂检测非小细胞肺癌前哨淋巴结（sentinel lymph node,SLN）的准确性及作用。方法：20例术前已确定的可手术切除的非小细胞肺癌患者。术前纤支镜注射18.5-55.5 MBq 99 Tcm-硫胶体,开胸后用伽马探测仪扫描原发肿瘤、肺门淋巴结及纵隔淋巴结的放射性数值。常规行肺切除术及淋巴结清扫术。切除后的肿瘤及淋巴结于体外分别再进行放射性计数。进行常规病理检查及疫免组化检测淋巴结内的转移灶。结果：17例患者检测到了SLN,其中12例被测到仅有1枚SLN,3例有2枚SLN,2例发现3枚SLN。该方法的敏感性是53%（9/17）,特异性是100%（3/3）。结论：纤支镜注射同位素可以用于SLN检测,能够更接近于患者生理状态地显示出SLN。

Objective：To determine the accuracy and the role of bronchoscopic radioisotope injection technique for detecting the sentinel lymph node（SLN）in patients with non-small cell lung cancer. Methods：Twenty patients with resectable non-small cell lung cancer（NSCLC） were included. A dosage of 18.5-55.5 MBq 99Tcm-labeled sulfur colloid was endoscopically administrated for patients before anesthesia. The radioactivity of primary tumor and background was gathered after thoracotomy with a hand-hold gamma probe. Patients underwent routine lung resection and mediastinal lymphadenectomy. Radiolabeled nodes were also examined in vitro separately. Routine pathological examination was implemented and immunohistochemistry（ICH）was carried out for micrometastases.Results：Identification of SLNs was in 17 patients. In 12 patients,a unique SLN was identified and in 3 patients two SLNs were detected,whereas in two patients,nodes from three different stations could be classified as SLNs. The sensitivity and specificity were 53%（9/17）and 100%（3/3）. Conclusion：Using bronchoscopic radioisotope injection technique to identify sentinel lymph node in patients with NSCLC is reliable. It could be a physiological way to map SLN.