南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2014年
7期
1053-1056
,共4页
洪斌%沈学远%陈江勇
洪斌%瀋學遠%陳江勇
홍빈%침학원%진강용
非小细胞肺癌%前哨淋巴结%亚甲蓝%99mTc-硫胶体
非小細胞肺癌%前哨淋巴結%亞甲藍%99mTc-硫膠體
비소세포폐암%전초림파결%아갑람%99mTc-류효체
non-small cell lung cancer%sentinel lymph nodes%methylene blue%9 mTc-sulfur colloid
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。
目的：通過評估亞甲藍單獨和聯閤99mTc-硫膠體覈素示蹤法在早期非小細胞肺癌（NSCLC）前哨淋巴結（SLN）定位的可行性，探討SLN概唸在NSCLC中的適用性。方法選擇我院2008年3月~2011年5月收治的早期NSCLC 61例為研究對象，術中行SLN示蹤劑註射併切除，其中註射亞甲藍35例，亞甲藍聯閤99mTc-硫膠體26例，併行肺葉切除+肺門及縱隔淋巴結清掃術，術後所有淋巴結均石蠟切片，行HE染色和抗細胞角蛋白抗體免疫組化檢查。結果單獨使用亞甲藍組的SLN檢齣率60.0%，準確性76.19%，靈敏度58.33%，陰性預測值和假陰性率分彆為90.0%和8.33%；亞甲藍聯閤99mTc-硫膠體組在檢齣率96.15%，準確性96.0%，靈敏度92.86%，陰性預測值和假陰性率分彆為91.67%和7.14%。結論（1）SLN的狀態能夠反映NSCLC肺門縱隔淋巴結是否轉移；（2）亞甲藍聯閤99mTc-硫膠體覈素示蹤法較單獨使用亞甲藍在前哨淋巴結導航中具有更高的檢齣率、準確性及靈敏度，是較好的肺癌SLN示蹤方法，可能運用于臨床。
목적：통과평고아갑람단독화연합99mTc-류효체핵소시종법재조기비소세포폐암（NSCLC）전초림파결（SLN）정위적가행성，탐토SLN개념재NSCLC중적괄용성。방법선택아원2008년3월~2011년5월수치적조기NSCLC 61례위연구대상，술중행SLN시종제주사병절제，기중주사아갑람35례，아갑람연합99mTc-류효체26례，병행폐협절제+폐문급종격림파결청소술，술후소유림파결균석사절편，행HE염색화항세포각단백항체면역조화검사。결과단독사용아갑람조적SLN검출솔60.0%，준학성76.19%，령민도58.33%，음성예측치화가음성솔분별위90.0%화8.33%；아갑람연합99mTc-류효체조재검출솔96.15%，준학성96.0%，령민도92.86%，음성예측치화가음성솔분별위91.67%화7.14%。결론（1）SLN적상태능구반영NSCLC폐문종격림파결시부전이；（2）아갑람연합99mTc-류효체핵소시종법교단독사용아갑람재전초림파결도항중구유경고적검출솔、준학성급령민도，시교호적폐암SLN시종방법，가능운용우림상。
Objective To compare the accuracy of intaoperative methylene blue alone and in combination with 9 mTc-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 9 mTc-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 9 mTc-sulfur colloid isotopic tracing allows accurate detection of the SLNs in early-stage NSCLC.
