纳米碳示踪前哨淋巴结活检在cN0期甲状腺乳头状癌患者中的应用

Application of nano-carbon tracing sentinel lymph node biopsy in patients with papillary thyroid carcinoma of cN0 stage

目的探讨纳米碳示踪在cN0期甲状腺乳头状癌(PTC)患者前哨淋巴结活检(SLNB)中的应用价值。方法 60例cN0期PTC患者以纳米碳为示踪剂活检Ⅲ、Ⅳ、Ⅵ区前哨淋巴结(SLN)并同时行淋巴结预防性清扫,对证实Ⅲ、Ⅳ区SLN和/或Ⅲ、Ⅳ区SLN以外淋巴结转移者行改良性颈部淋巴结清扫术。所有组织标本常规行病理检查。结果 54例行甲状腺腺叶切除或甲状腺全切除+Ⅲ、Ⅳ、Ⅵ区淋巴结预防性清扫,6例行改良性颈部淋巴结清扫术。SLNB检出率、灵敏度、特异度、假阴性率、假阳性率、准确率分别为76.7%、60.7%、100%、39.3%、0、76.1%。成功检出SLN的46例患者中,Ⅲ、Ⅳ、Ⅵ区同时出现SLN 17例,仅在Ⅵ区和仅在Ⅲ、Ⅳ区SLN出现9例和20例。全组淋巴结转移率达53.3%;其中,中央区及侧区淋巴结转移率达25.0%。结论纳米碳可作为一种理想的淋巴结示踪剂,对cN0期PTC患者行SLNB有助于早期发现淋巴结转移,指导手术范围,评估预后。

Objective To explore the value of nano-carbon tracing sentinel lymph node biopsy （SLNB） in patients with papillary thyroid carcinoma （PTC） of cN0 stage .Methods Sixty patients with cN0 stage PTC underwent SLNB with nano-carbon as a tracer in the regions of Ⅲ ,Ⅳ and Ⅵ and prophylactic lymph node dissections were conducted .PTC patients with positive SLN or other lymph node metastasis in the regions of Ⅲ and Ⅳ underwent modified radical neck dissections .All specimens were examined pathologically .Results Fifty-four PTC patients underwent thyroid lobectomy or total thyroidectomy combined with prophylactic dissections in the regions of Ⅲ ,Ⅳ and Ⅵ .Six patients underwent modified radical neck dissections .The detection rate ,sensitivity ,specificity ,false-negative rate ,false-positive rate and accuracy rate of SLNB were 76.7% ,60.7% ,100% ,39.3% ,0 and 76.1% , respectively .Among 46 patients with positive SLN ,17 cases were with SLN in the regions of Ⅲ ,Ⅳand Ⅵ ,9 cases and 20 cases were with SLN in Ⅵ region and in the regions of Ⅲ and Ⅳ ,respectively . Lymph node metastasis rate was 53.3% ,in which lymph node metastasis rate of central and side regions was 25.0% .Conclusion Nano-carbon may be taken as an ideal lymph tracer and is helpful in detecting lymph node metastasis ,guiding operation scope and evaluating prognosis in the patients with PTC of cN0 stage .