分化型甲状腺癌前哨淋巴结的临床病理研究

Clinicopathological study of sentinel lymph node in patients with differentiated thyroid carcinoma

目的 探讨检测分化型甲状腺癌前哨淋巴结（SLN）在预测颈部中央区淋巴结（CCLN）转移方面的价值。方法分析2013年1月~2015年12月首都医科大学宣武医院普外科253例分化型甲状腺癌患者,术中注射纳米炭后找到最先染色的SLN送冰冻病理,将其与CCLN术后石蜡病理进行对比,计算其阳性率。结果 253例患者均在术中成功找到SLN,平均5枚/例,其中假阴性率为21.1%,阳性预测值为81.8%,阴性预测值为78.7%。SLN活检数4~5个的诊断价值最大。结论 前哨淋巴结活检对于分化型甲状腺癌中央区淋巴结清扫有重要的指导意义,精准操作可以进一步提高其诊断价值。

Objective To investigate the value of sentinel lymph node （SLN） detection in predicting the metastasis of central cervical lymph nodes （CCLN）in differentiated thyroid carcinoma. Methods 253 patients with differentiated thy- roid carcinoma in Department of General Surgery, Xuanwu Hospital, Capital Medical University from January 2013 to December 2015 were analyzed. During the operation, carbon nanoparticles were injected and then to detect SLN which stained firstly by frozen pathology. Compared this results with the routine histopathology results of CCLNs and calculat- ed the positive rate. Results The detection rate of SLN was 100% and the average number of SLN was 5. The false negative rate, positive and negative predicted value of SLN to CCLN metastasis were 21.1%, 81.8%, 78.7%, respec- tively. When SLNs number reached 4-5, the diagnostic value was the highest. Conclusion There is an important pre- dicted value of SLN biopsy in CCLN excision for the patients suffered from differentiated thyroid carcinoma. It will be improved by precision operation.