前哨淋巴结活检技术在甲状腺乳头状癌外科手术中的应用价值及其可行性探讨

The application value and feasibility of sentinel lymph node biopsy in surgery of papillary thyroid carcinoma

目的探讨前哨淋巴结活检技术在甲状腺乳头状癌外科手术中的应用价值及其可行性。方法选取2017年5月~2019年3月我院收治的甲状腺乳头状癌患者88例,根据观察指标分析,对肿瘤分期:局部晚期(N3、M0或T2~3、N2;T4、所有N、M0)或早期(T2~3、N0~1、M0),采取随机化前完成所有必须的基线实验室测定和影像学检查。使用前哨淋巴结活检技术进行手术。前哨淋巴结活检技术作为重要的标准。探讨了检出结果分析、检出位置分析、肿瘤部位与SLN位置分析、SLNB的灵敏度、特异度、假阴性率、假阳性率及准确率计算。结果88例前哨淋巴结患者中,1枚淋巴结28例,占31.8%;2枚淋巴结32例,占36.4%;3枚淋巴结15例,占17.0%;4枚13例,占14.8%。所有检测出前哨淋巴结的甲状腺乳头状癌的患者中,灵敏度为39.8%(35/88);特异度为98.86%(87/88),假阴性率为11.4%(10/88),假阳性率为0,准确率为73.9%(65/88)。结论在甲状腺乳头状癌外科手术中,前哨淋巴结活检技术可以提高手术的效果。

Objective To explore the value and feasibility of sentinel lymph node biopsy in papillary thyroid carcinoma.Methods Eighty-eight patients with papillary thyroid carcinoma from May 2017 to March 2019 admitted to our hospital were selected.According to the analysis of observation indicators,the tumor was staged:early(T2-3.N0-1.M0)or locally advanced(T2-3,N2 or N3,M0,T4,all N.M0).The baseline laboratory determination and imaging must be completed before randomization.The sentinel lymph node biopsy technique was used for the operation.The sentinel lymph node biopsy technique was used for surgery and as an important standard.The detection result analysis,detection position analysis,tumor site and SLN position analysis,SLNB sensitivity,specificity,false negative rate,false positive rate and accuracy calculation were explored.Results Of the 88 patients with sentinel lymph nodes,28 had 1 lymph node,accounting for 31.8%;32 had 2 lymph nodes,accounting for 36.4%;15 patients had 3 lymph nodes,accounting for 17.0%;13 had 4 lymph nodes,accounting for 14.8%.Of all patients with papillary thyroid carcinoma who were detected with sentinel lymph nodes,the sensitivity,speci ficity,false negative rate,false positive rate and the accuracy rate was 39.8%(35/88),98.86%(87/88),11.4%(10/88),0,and 73.9%(65/88).Conclusion In the surgery of papillary thyroid carcinoma,the sentinel lymph node biopsy technique can improve the effect of the surgery,and also has certain guiding significance.It should be further promoted and applied clinically.