南方医科大学学报

南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (07): 1053-.

• • 上一篇    下一篇

联合亚甲蓝和99mTc-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

洪斌，沈学远，陈江勇   

  • 出版日期:2014-07-20 发布日期:2014-07-20

Intraoperative methylene blue and 99mTc-sulfur colloid isotope tracing for sentinel node
mapping in early-stage non-small cell lung cancer

  • Online:2014-07-20 Published:2014-07-20

PDF

1277

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。

Abstract: Objective To compare the accuracy of intaoperative methylene blue alone and in combination with 99mTc-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 99mTc-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 99mTc-sulfur colloid isotopic tracing allows accurate
detection of the SLNs in early-stage NSCLC.