宫颈癌前哨淋巴结检测的初步探讨  

Sentinel Lymph Node Identification with Methylene Blue in Cervical Cancer

作　　者：袁颂华[1] 梁立治[1] 刘继红[1] 张惠忠[2] 熊樱[1] 颜笑健[1] 魏梅[1] 张昌卿[3] 

机构地区：[1]中山大学肿瘤防治中心妇科,广东广州510060 [2]中山大学肿瘤防治中心病理科,广东广州510060 [3]中山大学肿瘤防治中心实验研究部,广东广州510060

出　　处：《癌症》2004年第9期1089-1092,共4页Chinese Journal of Cancer

摘　　要：背景与目的:近几年已开展宫颈癌前哨淋巴结(sentinellymphnode,SLN)的研究,目前影响宫颈癌SLN的检出还存在很多未知因素。本研究使用亚甲蓝作为示踪剂检测宫颈癌SLN,分析影响SLN检出的因素。方法:41例宫颈癌Ⅰb1～Ⅱb期患者,术前90～400min在宫颈瘤周分4～6点注射亚甲蓝2～4ml,蓝染淋巴结即定为SLN,术后将SLN行多层切片HE染色和细胞角蛋白(cytokeratin,CK)免疫组化,其余淋巴结作常规病理检查,根据SLN检出率、假阴性率来探讨使用亚甲蓝检测宫颈癌SLN的影响因素。结果:41例中,31例成功定位出SLN共85枚,总检出率为75.6%,最常见部位为闭孔窝淋巴结。其中未行术前放化疗者检出率为87.0%(20/23);已行术前放化疗者检出率为61.1%(11/18)。27例注射亚甲蓝量为2～3ml的患者检出率仅为63.0%(17/27),显著低于注射量为3.4～4ml的患者(100%,14/14)。病理结果示:一共8例患者有盆腔淋巴结转移。结论:使用亚甲蓝检测宫颈癌SNL的注射剂量以3～4ml为宜。宫颈癌SLN定位个体差异较大,以闭孔窝最多见。BACKGROUND &OBJECTIVE: Study of sentinel lymph node(SLN) in cerv ic al cancer has been initiated since recent years, and there are still a lot of un known factors about SLN identification in cervical cancer. This study was to inv estigate influential factors of identifying SLN with methylene blue in cervical cancer. METHODS: For 41 patients with cervical cancer enrolled from Jun. 2002 to May 2003, 2-4 ml of methylene blue was injected into cervix at 4-6 sites arou nd the tumor about 90-400 min before operation. The blue-dyed lymph node (BDLN ) was considered as SLN. HE staining in step sections, and immunohistochemistry were applied to detect SLN. The influential factors of using methylene blue to d etect SLN in cervical cancer were assessed based on the identification rate of S LN, and its false negative rate. RESULTS: SLNs were detected in 31 of 41(75.6%) patients with cervical cancer of stage Ⅰb1-Ⅱb. A total of 85 SLNs were ident ified,and most frequently located in obturator fossa. SLNs were successfully det ected in 20 of 23 (87.0%) patients who had no preoperative radiotherapy or chem otherapy, while in only 11 of 18 (61.1%) patients who had preoperative radiothe rapy and/or chemotherapy. SLNs were detected in only 17 of 27(63.0%) patients w ho were injected with 2-3 ml of methylene blue, while in all of 14 patients who se dose was 3.4-4 ml. Eight patients were confirmed of lymph node metastases by pathology. CONCLUSIONS: The dose of methylene blue recommended to detect SLN in cervical cancer is 3-4 ml. SLN varies in different sites, but most frequently located in obturator fossa.

关 键 词：宫颈肿瘤 前哨淋巴结 亚甲蓝 多层切片 免疫组化 

分 类 号：R737.33[医药卫生—肿瘤]