舌癌前哨淋巴结微转移检测的初步研究  

Primary study of sentinel node micrometastasis detection in squamous cell carcinoma (SCC) of the oral tongue

作　　者：王顺兰[1] 郭朱明[1] 张诠[1] 彭汉伟[1] 杨安奎[1] 伍国号[1] 曾宗渊[1] 

机构地区：[1]中山大学肿瘤防治中心头颈科,广州510060

出　　处：《实用肿瘤学杂志》2006年第4期261-264,共4页Practical Oncology Journal

基　　金：广东省医学科研基金资助(A2002226);广东省科技计划项目(2002-254-3)

摘　　要：目的探索舌癌前哨淋巴结(Sentinelnode,SN)微转移检测的适当方法及其预测颈部转移状况的功效。方法使用γ探头法、术前核素扫描+γ探头法、γ探头法+术中亚甲蓝示踪法进行SN检测,以颈清扫标本的常规病理结果为金标准,评价各方法的功效。石蜡切片病理检查阴性的SN进一步行多层切片+免疫组化检查。结果全组23例患者(其中初诊的cN020例、有手术史的cN01例、cN+2例)单用γ探头法,SN检出率为95.6%(2223),假阴性率为10.5%(219),准确率为91%(2022)。5例cN0患者使用术前核素扫描+γ探头法,SN检出率为100%,均为cN0pN0,无假阴性。11例cN0患者使用γ探头探测+染料示踪法检测,全部定位到SN,无假阴性;多层切片+免疫组化检查微转移发现率为6.7%(345)。结论舌癌SN活检的初步研究显示出良好的应用前景,但还需进一步研究。术前核素扫描与术中γ探头法、生物染料法相结合是舌癌SN检测的适当方法。连续切片+免疫组化可提高微转移灶的检出率。Objective The aim is to explore the suitable method to detect sentinel nodes （SN） and micrometastasis in squamous cell carcinoma of oral tongue, and to discuss whether SN could be prognostic of cervical metastasis. Methods SNs were detected by gamma probe detection alone, preoperative lymphoseintigraphy accompanies with gamma probe detection, gamma probe detection with intraoperative blue staining. The postoperative pathological results of neck dissection were considered as golden standard to evaluate the false negative and negative predictive value. Forty - five pieces of SN in negative routine pathological exam were given multilayer section and immunohistochemical staining to detect micrometastasis. Results In all 23 cases （including 20 cases with cN0 neck accepted no therapy before, 1 case with cN0 neck accepted primary resection before, .2 cases with cN＋ ）, identification rate of SN with gamma probe detecting alone was 95.6% （22/23）. The false negative was 10.5%（2/19）, and the acurate rate was 91%（20/22）, SNs were identified in 5 cases with cN0 by lymphoscintigraphy with gamma probe detection, all 5 cases with cN0pN0 necks, there were no false negative cases, and the acurate rate was 100%. The combination method of blue dye and radiocolloid was used in 11 cases of cN0. SNs were searched in all of them, and there were no false negative cases. Detecting rate of micrometastasis was 6.7 % （3/45） by multilayer section and immunohistochemical staining. Conclusion Primary study of SN biopsy shows promising in clinical use, further study is necessary. Combination method of blue dye, lymphoscintigraphy and gamma probe detection is an efficiency method to identify SN. Multilayer section and immunohistochemical staining could help to find micrometastasis.

关 键 词：舌肿瘤 前哨淋巴结 免疫组化 

分 类 号：R739.8[医药卫生—肿瘤]