摘要
目的:探讨前哨淋巴结(SLN)检测在胃癌诊断中的应用价值。方法:61例胃癌患者,术前经胃镜于病灶周围黏膜下注射锝标记的锍胶体,术中于病灶周围浆膜下注射亚甲蓝,待淋巴结蓝染后,用γ探测仪检测SLN,分析SLN的检出率、敏感性、准确率和阴性判断价值等。结果:本组SLN检出率为96.7%(59/61),SLN预测胃周淋巴结转移的敏感性为85.7%(18/21),假阴性率为14.2%(3/21),阴性判断价值为92.7%(38/41),准确率为94.9%(56/59)。SLN预测胃周淋巴结转移的敏感性随浸润深度增加而下降,T1期的敏感性为100.0%(6/6),T2期敏感性为88.9%(8/9),T3期为66.7%(4/6);T1+T2期总体敏感性为93.3%(14/15),准确性为98.1%(51/52)。假阴性的3例均为原发肿瘤>4.0cm的低分化癌或黏液腺癌。结论:联合染料与核素法有较高的SLN检出率,可较为准确地预测T1、T2期胃癌周围淋巴结转移状态,并可指导淋巴结清除范围。对肿瘤>4.0cm的低分化癌及黏液腺癌要警惕假阴性可能。
OBJECTIVE： To investigate the detection of feasibility and accuracy of sentinel lymph nodes（SLN）with combining the methylene blue and ^99Tc^m sulphur colloid injection in gastric cancer. METHODS： Sixty-one patients of gastric cancer were enrolled in this study. Endoscopic injection submucosally of ^99Tc^m-Sulphur colloid was performed around the primary tumor before operation. Immediately after laparotomy,methylene blue was injected into subserosal layer adja- cent to the tumor. After the methylene blue showing the lymph nodes mapping,SLNs were defined as the most radioactiv ity than surrounding tissue with 7 probe. The detection rate,diagnostic accuracy, sensitivity,and negative predictive value of regional lymph node status on the basis of SLN status were calculated respectively. RESULTS： SLNs were detected in 59 of 61 patients with a successful detection rate of 96.7%. The sensitivity, false negative rate, negative predictive value and diagnostic accuracy were 85.7%（18/21） ,14.2%（3/21） ,92.7%（38/41） and 94.9%（56/59） respectively. The sensitivity of SLN status lowered with the increasing invasion depth of gastric cancer. The sensitivity were 100.0% （6/6） in T1 stage,88.9%（8/9） in T2 stage and 66.7%（4/6） in T3 stage respectively. The sensitivity and accuracy of T1 ＋T2 stage were 93.3 % （14/15） and 98.1 % （51/52）. All the 3 false negative cases were poor differentiated cancer and mueinous ade nocarcinama with diameter more than 4.0 cm. CONCLUSIONS ： Combined agent SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with early gastric cancer and may indicate rational extent of lymphadenectomy for T1 ,T2 gastric cancer. However,it should be performed with caution for large tumours （〉4.0 cm） with a poor differentiated or mucinous histology.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2012年第10期777-779,共3页
Chinese Journal of Cancer Prevention and Treatment
基金
烟台市科技发展计划项目(20070045)
关键词
胃肿瘤
前哨淋巴结
亚甲蓝
99Tcm标记锍胶体
stomach neoplasms
sentinel lymph node
methylene blue
^99Tc^m-sulphur colloid
