利用纳米碳与亚甲蓝示踪甲状腺乳头状癌前哨淋巴结的对比研究

Comparison between carbon nanoparticles and methylene blue on cell tracking of sentinel lymph node for papillary thyroid carcinoma

目的探讨亚甲蓝和纳米碳混悬注射液细胞染色示踪甲状腺乳头状癌前哨淋巴结(SLN)的价值。方法选择130例甲状腺乳头状癌患者,按不平衡指数最小分配原则随机分为2组,分别用亚甲蓝及纳米碳行SLN活检术,记录SLN的位置及数目,随后行患侧功能性颈淋巴结清扫术,将SLN及清扫的淋巴结分别进行HE染色观察,采用t检验、c2检验、fisher确切概率法对数据进行统计学分析。结果亚甲蓝组65例检出SLN 52例,27例为阳性,其检出率、灵敏度、准确率和假阴性率分别为80.00﹪、84.38﹪、90.38﹪、15.62﹪。纳米碳组65例检出SLN61例,30例为阳性,其检出率、灵敏度、准确率和假阴性率分别为93.84﹪、90.91﹪、95.08﹪、9.09﹪,除检出率相比差异有统计学意义(c^2=5.482,P=0.019),灵敏度、准确率、假阴性率相比差异无统计学意义(fisher确切概率法,P=0.475、0.467、0.475)。两组所检出的SLN在各区的分布情况差异无统计学意义(c^2=1.043、P=0.791),两组均在Ⅳ区和Ⅵ区的检出率、阳性率最高,两组间差异无统计学意义(c^2=1.043,P=0.425;c^2=0.012,P=0.914)。结论纳米碳与亚甲蓝在甲状腺乳头状癌术中细胞示踪SLN均具有可行性,能准确反映颈部淋巴结的状况,对甲状腺乳头状癌淋巴结的清扫具有指导意义,纳米碳较亚甲蓝能获得较清晰的术野,对SLN检出率高,值得推广。

Objective To evaluate the value of methylene blue and carbon nanoparticles as cell tracer in the sentinel lymph node(SLN)for papillary thyroid carcinoma.Methods 130 patients with papillary thyroid carcinoma were enrolled in the study.The patients were divided into two groups randomly,which were given sentinel lymph node biopsy with either methylene blue or carbon nanoparticles.The sentinel lymph node location and number were recorded,followed by ipsilateral functional cervix lymph node dissection.Then the sentinel lymph node and dissected cervix lymph nodes were subject to pathology examination respectively.Experimental data were statistically analyzed by t test,chi-square test and fisher exact probability test when appropriate.Results In 65 patients in the methylene blue group,SLN were identified in 52 patients,with 27 having histopathologically positive lymph nodes.The detection rate,sensitivity,accuracy rate and false negative rate were 80%,84.38%,90.38%,and 15.62%,respectively.Whereas in the carbon nanoparticles group,SLN were identified in 61 patients,with 30 having histopathologically positive lymph nodes.The detection rate,sensitivity,accuracy rate and false negative rate were 93.84%,90.91%,95.08%,and 9.09%,respectively.The difference of the detection rate was significant(X2=5.482,P=0.019).There was no significantly difference on the distribution of the detected SLN in regions between the two groups(X2=1.043,P=0.791).The detection rate and positive rate of SLN were both highest in region IV and^in the two groups.And there was no significantly difference between the two groups(X2=1.043,P=0.425;X2=0.012,P=0.914).Conclutions Methylene blue and cabon nanoparticles are both feasible in intraoperative SLN identification.They could reflect lymphatic metastasis accurately and be instructive to cervix lymph nodes dissection.Carbon nanoparticles tracer provides clearer surgery field and has higher detection rate.