联合亚甲蓝和^(99m)Tc-硫胶体核素示踪法在早期非小细胞肺癌前哨淋巴结定位中的应用  

Intraoperative methylene blue and ^(99m)Tc- sulfur colloid isotope tracing for sentinel node mapping in early-stage non-small cell lung cancer

作　　者：洪斌[1] 沈学远[1] 陈江勇[1] 

机构地区：[1]重庆医科大学附属永川医院心胸外科,重庆402160

出　　处：《南方医科大学学报》2014年第7期1053-1056,共4页Journal of Southern Medical University

基　　金：重庆市卫生局课题(2011-2-264);重庆医科大学附属永川医院项目(YJYB2011012)

摘　　要：目的通过评估亚甲蓝单独和联合99mTc-硫胶体核素示踪法在早期非小细胞肺癌(NSCLC)前哨淋巴结(SLN)定位的可行性,探讨SLN概念在NSCLC中的适用性。方法选择我院2008年3月~2011年5月收治的早期NSCLC 61例为研究对象,术中行SLN示踪剂注射并切除,其中注射亚甲蓝35例,亚甲蓝联合99mTc-硫胶体26例,并行肺叶切除+肺门及纵隔淋巴结清扫术,术后所有淋巴结均石蜡切片,行HE染色和抗细胞角蛋白抗体免疫组化检查。结果单独使用亚甲蓝组的SLN检出率60.0%,准确性76.19%,灵敏度58.33%,阴性预测值和假阴性率分别为90.0%和8.33%;亚甲蓝联合99mTc-硫胶体组在检出率96.15%,准确性96.0%,灵敏度92.86%,阴性预测值和假阴性率分别为91.67%和7.14%。结论 (1)SLN的状态能够反映NSCLC肺门纵隔淋巴结是否转移;(2)亚甲蓝联合99mTc-硫胶体核素示踪法较单独使用亚甲蓝在前哨淋巴结导航中具有更高的检出率、准确性及灵敏度,是较好的肺癌SLN示踪方法,可能运用于临床。Objective To compare the accuracy of intaoperative methylene blue alone and in combination with 99m^Tc-sulfur colloid isotopic tracing for detection of sentinel lymph nodes （SLNs） in early-stage non-small cell lung cancer （NSCLC）. Methods Sixty-one patients with operable NSCLC who did not receive previous radiotherapy or chemotherapy were enrolled. Methylene blue and 99m^Tc-sulfur colloid were injected into the subserosal layer adjacent to the tumor, and SLNs were defined as those with blue staining or those containing 3 times more radioactivity than the surrounding tissue detected with a gamma probe. The SLN were removed with systematic lymph node dissection. All the removed lymph nodes were examined histopathologically with HE staining and immunohistochemistry. Results Methylene blue alone showed a low detection rate （60.0%） and sensitivity （58.33%） for SLNs compared with the combination of methylene blue and isotope tracing （96.15%and 92.86%, respectively）. Conclusion The combination of methylene blue and 99m^Tc-sulfur colloid isotopic tracing allows accurate detection of the SLNs in early-stage NSCLC.

关 键 词：非小细胞肺癌 前哨淋巴结 亚甲蓝 99m^Tc-硫胶体 

分 类 号：R734.2[医药卫生—肿瘤]