cN0舌癌前哨淋巴结定位方法研究

Optimized Methods of Sentinel Node Localization incN0 Tongue Carcinoma

背景与目的：由于没有任何临床检查方法或生化标志能准确的评价临床NO（clinically negative neck,cNO)舌癌颈部淋巴结转移的状况。因而，目前对cNO舌癌的颈部治疗存在一定的盲目性。前哨淋巴结（sentinel node,SN)活检的应用为指导cNO舌癌患者颈部的个体化治疗提供了依据。本研究旨在探讨SN活检能否准确评价cNO舌癌的颈部淋巴结转移状况，寻找舌癌前哨淋巴结定位的最佳方法。方法：使用术前核素扫描法和术中亚甲蓝示踪法对24例cNO舌癌患者进行SN示踪，研究SN活检在评价cNO舌癌颈部淋巴结转移状况中的作用。对比核素扫描法，亚甲蓝示踪法，两法结合示踪法的优缺点。结果：3种方法全组SN检出率均为100%，24例中有4例手术标本发现有颈淋巴结转移（即隐匿性颈淋巴结转移，cNOpN^+)，SN活检对全组病例颈部淋巴结转移状况评价的准确率为100%。无假阴性；平均检出SN数目；核素扫描法3.5枚/例，亚甲蓝示踪法2.7枚/例，两法结合示踪法2.2枚/例。结论：核素扫描法和亚甲蓝示踪法均能有效地对cNO舌癌进行SN定位并准确地评价颈部淋巴结转移状况，两法结合SN示踪法最为准确。并且具有可操作性和实用性。

BACKGROUND &OBJECTIVE: At present, there is no clinical examination and biochemical marker available to assess the lymph node status of tongue carcinoma with clinically negative neck (cN0) accurately. Therefore, the treatment of the cN0 neck in tongue carcinoma is of blind to some extent. Application of sentinel node(SN) biopsy may possibly bring about the individualized management of the cN0 neck of tongue carcinoma. This study was designed to assess whether lymph node status can be accurately evaluated by SN biopsy and to screen out the optimized sentinel node localization method. METHODS: Preoperative nuclear lymphoscintigraphy and intraoperative methylene blue dye mapping were performed in 24 cases of tongue carcinoma to reveal the efficacy of sentinel node biopsy in evaluating the lymph node status in cN0 tongue carcinoma. Shortcomings and advantages of lymphoscintigraphy, methylene blue dye mapping and combination of both methods were discussed. RESULTS: Sentinel nodes were detected in all cases with both methods. Sentinel nodes were found with metastasis in 4 cases. No non sentinel node was found with metastasis while sentinel nodes were pathologically negative. The detection rates were 3.5 sentinel nodes per case by lymphoscintigraphy, and 2.7 by methylene blue dye, while only 2.2 sentinel nodes by combined methods. CONCLUSION: Either lymphoscintigraphy or methylene blue dye mapping can be used to assess the cervical lymph node status of cN0 tongue carcinoma accurately. Combination with both methods is the most efficient and practicable method in sentinel node detection.