LungPoint导航联合吲哚菁绿荧光成像在Ⅰa期非小细胞肺癌淋巴结采样中的应用价值  

Application of LungPoint navigation combined with indocyanine green fluorescence imaging in lymph node sampling of stage Ia non-small cell lung cancer

作　　者：朱建坤[1] 刘大伟[1] 李晓峰[1] 孟倩 Zhu Jiankun;Liu Dawei;Li Xiaofeng;Meng Qian(Department of Thoracic Surgery,Shandong Provincial Public Health Clinical Center,Shandong University,Ji'nan 250100,China;Department of Pediatrics,Affiliated to Hospital of Shandong Academy of Medical Sciences,Ji'nan 250031,China)

机构地区：[1]山东大学附属山东省公共卫生临床中心胸外科,济南250100 [2]山东省医学科学院附属医院儿科,济南250031

出　　处：《结核与肺部疾病杂志》2024年第2期101-105,共5页Journal of Tuberculosis and Lung Disease

基　　金：山东省医药卫生科技发展计划项目(202004021499,202004021514)。

摘　　要：目的:寻找一种准确定位Ⅰa期非小细胞肺癌患者(NSCLC)前哨淋巴结(SLN)的方法,验证SLN作为淋巴结取样样本的合理性。方法:采用前瞻性研究方法,参照入组标准纳入2021年1月至2023年12月在山东省公共卫生临床中心胸外科临床分期为Ⅰa期NSCLC住院患者50例,术前借助LungPoint导航气管镜下肿瘤周围注射示踪剂吲哚菁绿,通过荧光胸腔镜成像完成SLN定位,并对包括SLN在内的区域淋巴结行病理学检查,使用该方法对SLN的识别率、准确率与假阴性率等验证其作为淋巴结取样样本的合理性。结果:50例患者中,41例检测到SLN,识别率为82.0%(41/50),经病理检测发现3例共计9枚SLN有淋巴结转移(阳性),其中1例亦检出非前哨淋巴结(N-SLN)阳性2枚。9例患者未检测到SLN,清扫淋巴结54枚,未发现转移淋巴结,故SLN准确率为100.0%(41/41),假阴性率为0(0/3)。结论:借助LungPoint气管镜在肿瘤周围注射示踪剂吲哚菁绿,通过荧光胸腔镜成像探寻SLN技术具有较高的区域淋巴结转移预测性,有望成为指导Ⅰa期NSCLC系统性淋巴结采样的依据。Objective:To find a method to accurately locate sentinel lymph nodes(SLN)in patients with stage Ia non-small cell lung cancer(NSCLC)and to verify the rationality of SLN as a lymph node sample.Methods:A prospective study was conducted to include 50 patients with stage Ia NSCLC in the Thoracic Surgery Department of Shandong Provincial Public Health Clinical Center from January 2021 to December 2023 according to the enrollment criteria.The tracer indocyanine green was injected around the tumor by LungPoint navigation tracheoscopy before surgery,and SLN localization was completed by fluorescence thoracoscopic imaging.The pathological examination of regional lymph nodes including SLN was performed,and the recognition rate,accuracy rate and false negative rate of SLN were used to verify the rationality of the method as a lymph node sampling sample.Results:Among the 50 patients,SLN was detected in 41 cases,with a recognition rate of 82.0%(41/50),of which 3 patients were detected with lymph node metastasis(SLN positive),a total of 9 lymph nodes,and 1 patient also detected 2 positive non-sentinel lymph nodes(N-SLN).In 9 patients,no SLN was detected,54 lymph nodes were dissected,and no metastatic lymph nodes were found,so the accuracy rate of SLN was 100.0%(41/41)and the false negative rate was O(o/3).Conclusion:With the help of LungPoint tracheoscopy to inject the tracer indocyanine green around the tumor,the SLN technology explored by fluorescence thoracoscopic imaging has a high predictability of regional lymph node metastasis,which is expected to be the basis for guiding the systematic lymph node sampling of stage Ia NSCLC.

关 键 词：癌 非小细胞肺 前哨淋巴结活组织检查 吲哚花青绿 显微镜检查 荧光 

分 类 号：R734.2[医药卫生—肿瘤] R443.8[医药卫生—临床医学]