非小细胞肺癌前哨淋巴结活检示踪技术及其临床意义研究  

Comparion study of detecting sentinel lymph nodes for clinical early non-small cell lung cancer

作　　者：张曙光[1,2] 陈晨[1,2] 张百江[2] 宋平平[2] 李广旭[2] 刘希斌[2] 王国范[2] 

机构地区：[1]济南大学.山东省医学科学院医学与生命科学学院,山东济南250000 [2]山东省肿瘤医院外六病区,山东济南250117

出　　处：《中华肿瘤防治杂志》2013年第20期1600-1603,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省自然科学基金(Y2008C150;ZR2011HM089)

摘　　要：目的:通过比较不同示踪剂在非小细胞肺癌(non-small cell lung cancer,NSCLC)前哨淋巴结(sentinel lymph node,SLN)中的应用特点,研究SLN预测早期NSCLC区域淋巴结转移的应用价值。方法:收集我院手术切除的临床Ⅰ期NSCLC患者88例,随机分为4组,术中分别注射亚甲蓝溶液(A组,32例)、纳米碳混悬液(B组,27例)、99锝硫胶体(99 Technetium sulfur colloid,99 TcmSC)溶液(C组,17例)及亚甲蓝联合99 TcmSC(D组,12例),对肺癌SLN进行识别。常规行肺叶切除,将探测到的SLN和纵隔淋巴结分别切除。最终以病理诊断作为标准。结果:A组的SLN检出率为59.4%(19/32);B组为63.0%(17/27);C组为76.5%(13/17)和D组为91.7%(11/12)。D组显著高于前三组,P=0.042。A组SLN预测区域淋巴结转移的准确率、敏感性、阴性预测值和假阴性率分别为89.5%、66.7%、86.7%和10.5%;B组为94.1%、75.0%、92.8%和5.9%;C组为92.3%、80.0%、88.8%和7.7%,D组为100.0%、100.0%、100.0%和0。C组SLN放射性计数值为6208±3206,非SLN为1324±476,差异有统计学意义,P=0.045;D组SLN为6315±3423,非SLN为1438±537,差异有统计学意义,P=0.047。结论:染料和放射性同位素可适用于SLN检测,联合法检测SLN具有更好的可行性。SLN一定程度可反映临床早期NSCLC区域淋巴结的转移状态,有助于提高对区域淋巴结转移的准确预测。OBJECTIVE： By comparing the characters of different tracer in detecting sentinel lymph node（SLN） for early non small cell lung cancer（NSCLC）, the application value of SLN predicting regional lymph node metastasis was re searched in early NSCLC. METHODS： A total of 88 patients with clinical stage NSCLC in my hospital from June 2010 to November 2012 were divided into four groups,32 patients were given methylene blue solution injection before opertion （group A）,27 patients were given activated carbon nanoparticles （group B）, 17 patients were given 99Technetium sulfur colloid solution （group C） and 12 patients were given both methylene blue and 99Technetium sulfur colloid （group D）. Loire resection was performed,SLN and mediastinal lymph nodes detected were resected respectively. The pathological di agnosis was final standard. RESULTS： The detection rates were 59. 4% （19/32）, 63. 0% （17/27）, 76. 5% （13/17） and 91.7 % （l 1/12） in group A, B, C and D, respectively. The detection rate of group D was significantly higher than that inprevious three group（P= 0. 042）. Accuracy, sensitivity, negative predictive value and false negative rate of SLN predicting regional lymph node metastasis were 89.5%,66.7%,86.7% and 10.5% in group A;94.1%,75.0% ,92.8% and 5.9% in group B92. 3%,80. 0% ,88.8%and 7.7% in group C and 100.0%,100.0%,100.0% and 0 in group D,respeetively. Radioacti-Jity count of SLN was signifeantly higher than that of Non-SLN node in group C（6208±3206 vs 1324± 476, P=0. 045） and group D （6315±3423 vs 1438±537,P=0. 047）. CONCLUSIONS： Dye and radioisotope are suitable for SLN detection Combined method has better feasibility in SLN detection;SLN can reflect the states of regional lymph node metastasis in a certain degree for clinical early NSCLC and it is helpful to improve prediction accuracy of regional lymph node metastasis.

关 键 词：前哨淋巴结 染色与标记 早期 癌 非小细胞肺 转移 预测 

分 类 号：R734.2[医药卫生—肿瘤]