前哨淋巴结^(99)Tc^m-右旋糖苷SPECT显像在cN0期口腔鳞癌中的应用  

Sentinel Lymph Node Lymphoscintigraphy in cN0 Oral Squamous Cell Carcinoma

作　　者：丁勇[1] 布静秋[2] 田嘉禾[1] 步荣发[2] 徐白萱[1] 邵明哲[1] 

机构地区：[1]解放军总医院核医学科,北京100853 [2]解放军总医院口腔科,北京100853

出　　处：《同位素》2007年第3期149-153,共5页Journal of Isotopes

摘　　要：采用蓝染法9、9Tcm-右旋糖苷单光子发射计算机断层(SPECT)淋巴核素显像法、术中γ探测法对31例cN0期口腔鳞癌(OSCC)患者进行前哨淋巴结(SLN)检测、淋巴结常规病理、连续切片和细胞角蛋白AE1/AE3免疫组化(IHC)检测,评价淋巴核素显像对cN0期口腔鳞癌颈部淋巴结转移状态的意义。结果表明,蓝染法、γ探测、SPECT淋巴显像三种方法分别检测出25(80%)、31(100%)、30(96.5%)例,SPECT检测出1例对侧SLN,6枚/8枚SLN转移阳性淋巴结位于SPECT显示的最热点/次热点,连续切片及IHC检测出常规病理与SPECT核素显像不能显示的2枚微转移淋巴结。因此,前哨淋巴结核素显像能有效地检测出cN0期口腔癌患者SLN,避免对侧SLN的遗漏。热点与次热点前哨淋巴结活检(SLNB)能反映大多数cN0期口腔癌患者颈部淋巴结转移状态。核素显像难以显示微小转移淋巴结。To assess the feasibility of lymphoscintigraphy of sentinel lymph node biopsy （SLNB） in the staging of cN0 oral squamous cell carcinoma（OSCC）, the SLN of 31 cases in cN0 is detected using a preoperative lymphoscintigraphy and intraoperative detection by both blue-dye and gamma-ray probe. Complete neck dissections are performed for all cN0 patients. Routine pathology and serial sectioning of SLN and cytokeratin immunohistochemical staining are employed to evaluate micrometastasis. The primary results show that the blue-dye, lymphoscintigraphy and gamma-ray probe could identify the SLN in 25 （80%）, 31（100%） and 30（96.5%） patients respectively. The SLNs locate principally in Ⅰ , Ⅱ , Ⅲ level of neck. The contralateral SLNs are identified by lymphoscintigraphy in one patient. 6/8 metastases are identified by routine pathological examination and locate the highest and the second highest node of lymphoscintigraphy. The SLNs with the highest and the second highest radioactivity reflecte the majority patients neck status. Serial section and IHC stains on SLNs detecte out another 2 micrometastasis. Lymphoscintigraphy preoperative can identify the contralateral SLNs, and avoid the mission of contralateral SLNs.

关 键 词：口腔鳞癌 前哨淋巴结 核素显像 微转移 连续病理切片 免疫组化 

分 类 号：R817.4[医药卫生—影像医学与核医学] R739.85[医药卫生—放射医学]