纳米炭引导下锝标锡胶体示踪检测胃癌前哨淋巴结  

Sentinel Lymph Node Detection by Combining the Carbon Nanoparticles Suspension Injection and ^(99m)Tc-Labeled Tincolloid in Gastric Cancer

作　　者：陈晓耕[1] 林志武[1] 林志彬[1] 林镇和[1] 林肖鹰[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院肿瘤科,福州350001

出　　处：《福建医科大学学报》2008年第3期274-276,共3页Journal of Fujian Medical University

摘　　要：目的评估胃癌前哨淋巴结(SLN)活检预测胃癌区域淋巴结转移状态的价值及其指导胃癌淋巴结清扫范围的临床意义。方法37例胃癌患者,术前经胃镜于病灶周围黏膜下注入锝标记的锡胶体,术中于病灶周围浆膜下注入纳米炭,将放射活性最高的淋巴结视为胃癌SLN,术中行冰冻免疫组织化学染色和病理检查或术后常规组织化学染色,分别计算SLN活检的准确性、敏感性、阴性预测值和假阴性率,并根据结果决定手术方式。结果SLN检出率100%(37/37),每例检出(2.4±0.8)个(1~5个)。胃癌SLN仅限于N1分布的占86.5%(32/37),仅限于N2或N3分布的占10.8%(4/37)。SLN活检的准确性97.3%,敏感性95.2%,阴性预测值94.1%,假阴性率5.9%。结论SLN概念适合于胃癌;纳米炭引导下锝标锡胶体示踪检测胃癌SLN可准确预测胃癌周围淋巴结的转移状态,并可指导胃癌的淋巴结清扫范围。Objective To investigate the feasibility and accuracy of sentinel lymph nodes（SLN）detection with combining the carbon nanoparticles suspension and ^99mTc-tincolloid injection in gastric cancer and assess its potential role in extent lymphadenectomy of gastric cancer surgery. Methods Thirty-seven patients of gastric cancer were enrolled in this study. ^99mTc labeled tincolloid was injected into submucosa around the tumor by endoscopes before operation. Then carbon nanoparticles suspension was injected into subserosal layer adjacent to the tumor during operation. SLN were defined as the most radioactive accumulation than surrounding tissue detected with gamma-probe. Those recected SLN were examined by rapid frozen cytokeratin immunohistochemistic stain during operation and routine H-E or by further cytokeratin immunohistochemistical staining postoperatively. The diagnostic accuracy, sensitivity, negative predictive value and false-negative rate of regional lymph node status on the basis of SLN status were calculated respectively. Results SLN were detected in 37 of 37 patients with a success rate of 100%. The number of SLN ranged from 1 to 5, with a mean value of 2.6 per case. The SLN of gastric cancer were only found in N1 area in 86.5% of the cases, and only in N2 or N3 in 10.8%. The diagnostic accuracy, sensitivity, negative predictive value and false-negative rate were 100%, 95.2%, 94. 1% and 5.9% respectively. Conclusion The SLN concept is validated in gastric cancer. Combined-agent SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in gastric cancer and may indicate the rational extent for lymphadenectomy in gastric cancer.

关 键 词：胃肿瘤 前哨淋巴结活组织检查 淋巴结转移 淋巴结切除术 锝 锡 生物相容性材料 

分 类 号：R735.2[医药卫生—肿瘤]