γ探针对肺癌胸内转移淋巴结的检测

Detection of intrathoracic metastatic lymph nodes from lung cancer by radioguidance

目的 探讨γ探针对肺癌胸内淋巴结廓清术的临床意义。方法 肺癌患者 2 0例 ,肺部良性病变 10例 ,手术前 3 0～ 40min静脉注射99Tcm 甲氧基异丁基异腈 (MIBI) ,开胸后用γ探针探测肺内和纵隔淋巴结及切除的标本 ,术后对辐射导向手术判定为阳性而术后常规病理检查为阴性的淋巴结 ,即假阳性进行连续切片 ,HE染色 ,显微镜下观察。结果 应用γ探针探测淋巴结 ,其灵敏度为10 0 % ,特异性为 96.3 % ,准确性为 96.9% ,假阴性率 0 ,假阳性率 3 .7%。术中探测发现最小的转移淋巴结为 0 .0 98g。结论 γ探针法在术中能更直接、更客观地提示肿瘤及其浸润、转移范围 。

Objective To detect 99Tc m-MIBI labeled lesions in cases of lung cancer by Gamma-detecting probe (GDP), and to discuss its clinical significance in intrathoracic clearance of lymph nodes. Methods Thirty patients,who underwent surgical operation in 2001 in Department of General Thoracic Surgery, were included. Lymph nodes, lung tissue and lesions of the patients were probed by GDP and specimens were acquired by radioimmunoguided surgery (RIGS). After operation,RIGS(+) but pathology (-) nodes (false positive ones) were serially sectioned and HE-stained, some of the sections even immunohistochemically stained for further histopathological study. Results The sensitivity of GDP detection was 100%, the specificity was 96.3%, and the accuracy was 96.9%. The weight of the smallest metastatic lymph node was 0.098 g. Conclusions RIGS is more accurate with using GDP than using HE staining.It may indicate tumors and their infiltrative lesions directly and objectively, and can help the surgeons to make reasonable choices, and thus it becomes a more effective method to increase the cure rate of patients with lung cancer and improve their life quality.