99mTc-DX显像对直肠癌APLANP手术的指导意义

目的探讨99mTc-DX核素显像对中低位直肠癌保留盆腔自主神经(PANP)的侧方淋巴结清扫术的临床指导意义。方法67例经病理证实为中低位直肠癌患者,经肛门镜直肠黏膜下注射37MBq/0.8mL99mTc-DX,注射后30min及1,2,3,4,6,12,24h分别行盆腔及下腹部核素显像。根据显像结果决定手术方法,并将术后病理与显像结果进行对比。结果37例显像阳性,均为单侧,行保留盆腔自主神经的侧方淋巴结清扫,术后经病理证实符合26例(70.3%%),假阳性11例(29.7%);30例显像阴性者中,2例术中发现有侧方淋巴结转移,行侧方清扫及部分PANP,其余28例未行侧方清扫而行Ⅰ型PANP。两组患者术后的性功能良好率分别为74.4%和71.4%;排尿功能轻度障碍和良好率均为100%。结论99mTc-DX核素显像对中低位直肠癌是否行保留盆腔自主神经的侧方淋巴结清扫具有一定的指导意义。     

直肠癌病人术前淋巴管造影和放射性核素淋巴显像的临床价值评价43例报告

目的评价直肠癌病人术前淋巴管造影和放射性核素淋巴显像的临床价值。方法选择直肠癌术前病人４３例于术前一周分别行淋巴管造影１８例,放射性核素淋巴显像２５例,将结果与术后病理学检查进行比较。结果淋巴管造影符合率８８％（１６／１８）;放射性核素淋巴显像符合率５２％（１３／２５）。结论淋巴管造影,影像清晰,诊断容易,准确率高,对侧方清除及腹主动脉旁廓清有指导意义。放射性核素淋巴显像,显示淋巴区域广泛,操作简单,无并发症,但缺点是显示图像粗略,反映一组淋巴结图像,缺乏特异性。但对无淋巴结转移病例符合率较高,仍有其临床意义。     

中低位直肠癌侧方淋巴结转移影像学的诊断价值

目的:探讨术前影像学检查手段对于中低位直肠癌侧方淋巴结转移诊断、手术中侧方淋巴结的清扫策略及患者预后的意义。方法:本研究纳入79例行侧方淋巴结清扫的中低位直肠癌患者共计112枚侧方淋巴结,探讨其术前影像学中侧方淋巴结影像学特征、临床特点与侧方淋巴结转移的关系。结果:38例（48%）患者的术后病理证实为侧方淋巴结转移。转...     

462例中下段直肠癌淋巴转移规律与淋巴清扫范围的分析

目的 探讨中下段直肠癌的淋巴转移规律和淋巴清扫范围。方法 对1990－1999年行传统直肠癌根治术的373例和行传统直肠癌根治术加盆腔侧方淋巴清扫术（简称侧方清扫术）的89例中下段直肠癌患者进行回顾性分析。结果 全组淋巴转移率为41．8％,患者年龄、癌灶浸润深度、大体分型、癌灶大小是影响淋巴转移率的重要因素（P＜0．05）。89例侧方清扫术的盆腔侧方淋巴转移率为15．7％,其中85．7％位于癌灶同侧。有盆腔侧方淋巴结转移者均为浸润深度T3、T4者;癌灶＞3cm、溃疡型或浸润型、年龄＜60岁者盆腔侧方淋巴结转移较高。侧方清扫术组的盆腔复发率为5．6％,明显低于传统直肠癌根治术组的17．7％（P＜0．05）;侧方清扫术组和传统直肠癌根治术组的5年生存率分别为46．7％和47．9％（P＞0．05）。结论 应提高对中下段直肠癌淋巴转移规律的认识,对怀疑或证实有淋巴结转移、癌灶侵犯浆膜或穿透肠壁、癌灶＞3cm、溃疡型或浸润型、年龄＜60岁者建议行侧方清扫术。     

下段直肠淋巴引流途径和低位直肠癌侧方淋巴结清扫的必要性

下段直肠癌已被证明存在向上、向下、侧方3个淋巴引流途径，直肠癌通过侧方淋巴引流途径形成的淋巴结转移是其治疗后盆腔复发的重要原因。大量循证医学证据表明，术前同步放化疗并不能彻底清扫侧方转移淋巴结，其阳性残留比例>60%。对术前同步放化疗后仍然存在侧方淋巴结转移的病例，手术清扫转移淋巴结是最重要的治疗手段，甚至是病人获得长期生存的惟一途径。严格掌握侧方淋巴结清扫指征，提高病理学检查准确率，进行规范的淋巴结清扫，通过精准操作降低手术并发症发生率，有望为直肠癌侧方淋巴结转移病人带来局部复发率的下降和生存延长的双重获益。     

低位直肠癌术中侧方淋巴结清扫的应用价值

目的探讨侧方淋巴结清扫应用于低位直肠癌的价值。方法对41例低位直肠癌患者随机分为侧方清扫组30例，行直肠癌扩大根治术（包括上方、侧方淋巴结清扫）；传统清扫组11例，行传统直肠癌根治术。结果侧方清扫组7例发生侧方淋巴结转移，转移率23．33％，低分化腺癌及黏液腺癌发生侧方淋巴结的转移率比高、中分化腺癌高出4倍多，差异有统计学意义（P〈0．05）。两组手术时间、失血量比较差异无统计学意义（P〉0．05），但侧方清扫组3年生存率比传统清扫组高22．12％。结论对低位直肠癌行侧方淋巴结清扫可降低盆腔复发，改善患者的生存质量，提高生存率，具有临床应用价值。     

侧方淋巴结清除在直肠癌根治术中的临床意义

目的：探讨侧方淋巴清除在直肠癌根治术中的临床意义。方法：对36例低位进展期直肠癌患者行根治术，清除上方3组淋巴结的同时行侧方淋巴结清除，对分组淋巴结的转移情况进行评价。结果：36例中有19例有侧方淋巴结转移，其中侧方淋巴转移5例，占阳性淋巴结病例的26．3％（5／19），占全部病例的13．9％（5／36），结论：为保证根治手术的彻底性，减少肿瘤复发，对腹膜返折部以下的进展期直肠癌除上方淋巴结必须清除达第3站外，有必要同时进行侧方淋巴清除。     

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目的 探讨中下段直肠癌侧方淋巴结转移规律及影响因素。方法 对1995－2000年行侧方淋巴结清扫的105例直肠癌病人进行回顾性分析。结果 中下段直肠癌侧方转移率为21％，肿瘤的大小、部位、病理分型、分化程度及浸润深度是影响侧方转移的重要因素。在侧方淋巴结转移阳性病人中，单纯闭孔及髂内淋巴结转移阳性病人占54．5％，单纯髂外及髂总淋巴结转移阳性病人为18．1％。侧方淋巴结转移阴性病人术后局部复发率为6．7％，阳性病人为36．3％。行侧方清扫局部复发率较传统术式由17．6％降至11．4％。侧方转移阴性病人平均生存期为88个月，阳性病人为37个月，二者差异有显著性。结论 侧方淋巴转移是中下段直肠癌淋巴转移的重要途径。闭孔和髂内淋巴结是侧方淋巴结清扫中需要着重清扫的部位。侧方淋巴清扫较传统术式可明显降低局部复发率。     

中低位直肠癌侧方淋巴结转移的危险因素分析

目的探讨影响中低位直肠癌患者侧方淋巴结转移的相关因素。方法回顾性分析新疆医科大学附属肿瘤医院2004年6月至2010年6月间行根治性切除并侧方淋巴结清扫的203例中低位直肠癌（距肛缘10cm以内）患者的临床资料,采用多因素Logistic回归模型分析侧方淋巴结转移的危险因素。结果203例中低位直肠癌患者共清扫侧方淋巴结3349枚,平均清扫17枚／例,阳性淋巴结数221枚。侧方淋巴结转移度为6．6％（221／3349）。单因素分析显示,年龄、家族史、肿瘤长度、大体类型、组织类型、分化程度、浸润深度、侵犯周径、术前CEA、脉管癌栓、上方淋巴结转移与中低位直肠癌侧方淋巴结转移有关（均P〈0．05）。多因素分析显示,低龄、低分化、浸润型、T4期及存在上方淋巴结转移是中低位直肠癌患者侧方淋巴结转移的独立高危因素（均P〈0．05）。结论对于低龄、低分化、浸润型、T4期及存在上方淋巴结转移等中低位直肠癌患者,由于具有较高的侧方淋巴结转移概率．采用选择性侧方淋巴清扫的手术方案更为合理。     

低位直肠癌侧方淋巴结清扫的临床意义

目的：探讨侧方淋巴结清扫在低位直肠癌治疗中的意义。方法：回顾性分析782例低位直肠癌以扩大淋巴结清扫的方法清扫直肠癌上方、侧方及部分下方的淋巴结。应用常规病理学的方法观察其侧方淋巴结转移的规律，并以直接方法统计侧方转移阳性病例的生存率。结果：①侧方淋巴结转移是腹膜返折以下直肠癌的转移途径，约占该部位直肠癌的12．5％；②侧方淋巴结转移易发生在低分化腺癌及粘液腺癌。肉眼见有浸润倾向者，侧方淋巴结转移与浸润深度有关；③侧方转移者5年生存率为42．2％。结论：腹膜返折以下的进展期直肠癌应该在上方淋巴结清扫的同时行侧方淋巴结清扫，可以避免转移淋巴结的残留，提高生存率。     

Periareolar injection for localization of sentinel nodes in breast cancer patients

The goal of this study was to evaluate the periareolar injection of technetium 99m sulfur colloid to identify axillary sentinel nodes and compare the number of sentinel lymph nodes identified with preoperative lymphoscintigraphy to intraoperative biopsy using a handheld gamma probe. A total of 104 consecutive patients diagnosed with invasive breast cancer participated in this prospective study, with 81 patients receiving an intradermal periareolar injection and 23 patients receiving an intradermal peritumoral injection of filtered technetium 99m sulfur colloid. Preoperative lymphoscintigraphy was performed for sentinel node mapping and localization. In addition to selective sentinel node biopsy, axillary dissection was performed on all patients to determine false-negative rates. Routine histologic staining was performed on all identified nodes, along with immunohistochemical staining of sentinel nodes negative on initial routine staining. With an intradermal periareolar injection, the sentinel node identification rate was 91.4% (74/81), axillary metastatic rate 35.1% (26/74), sentinel node positive only 61.5% (16/26), and false negative 3.8% (1/26). With an intradermal peritumoral injection, the sentinel node identification rate was 91.3% (21/23), axillary metastatic rate 42.9% (9/21), sentinel node positive only 88.9% (8/9), and false negative 0% (0/9). A total of 241 sentinel nodes were identified with biplanar lymphoscintigraphy and 173 sentinel nodes were harvested during surgery, yielding a 28.2% increase in sentinel nodes identified with lymphoscintigraphy. This study demonstrates that intradermal periareolar injection of filtered technetium 99m sulfur colloid is successful in identifying axillary sentinel nodes with a low false-negative rate. Preoperative lymphoscintigraphy aids in the identification and surgical planning of sentinel node biopsy and provides an objective measure of surgical performance.     

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??Study on sentinel lymph node biopsy by carbon nanoparticles and 99mTc sulfur colloid for rectal cancer TONG Han-xing, ZHAO Gang, LU Wei, et al. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai200032,China Corresponding author: LU Wei-qi??E-mail: weiqi_lu@eastday.com Abstract Objective To evaluate the feasibility of sentinel lymph node ??SLN??biopsy (SLNB) after carbon nanoparticles (CNP) and 99mTc sulfur colloid (TSC) injected in rectal cancer patients. Methods Twenty-eight patients underwent radical resection of a primary rectal cancer between October 2004 and September 2006 at Zhongshan Hospital of Fudan University were considered for inclusion. During resection, SLN mapping was performed with CNP and TSC. All lymph nodes were stained with HE. SLNs with negative routine HE staining were further analyzed with cytokratin 20 immunohistochemistical??CK20-IHC??staining. Results Fifty-two nodes ( 2 per patient) were identified as SLNs in 27 of 28 patients. In 18 of 27 patients, with SLNs and nonSLNs proven negative by HE staining, 5 patients showed positive SLNS by CK20-IHC. The accuracy rating and the false-negative rate of HE staining for SLN were 92.59% and 10% respectively. Conclusion SLNB by CNP and TSC for rectal cancer is feasible. Rectal cancer SLNB should apply different mapping method based on the lesion position.     

乳腺癌前哨淋巴结解剖学定位的临床研究

目的:探讨示踪剂注射部位对乳腺癌前哨淋巴结(sentinel lymph node,SLN)定位的影响。方法:对53例cN0期乳腺癌患者行核素示踪联合染料染色示踪法检测SLN,在原发肿瘤表面的皮下组织内或切除活组织检查残腔肿瘤周围两点注射99m锝(99mTc)标记的硫胶体,将卡纳琳或亚甲蓝分别注射于肿瘤对角线相应部位的皮下组织内(30例)或乳头乳晕下皮下组织内(23例)。SLN活组织检查后再行腋窝淋巴结清除术,标本行常规HE染色组织学检查。结果:53例患者均成功检测出SLN,核素示踪法与蓝染料法的成功率均为96.23%(51/53),联合检测的成功率100%(53/53),共检出SLN103枚,平均每例检出1.94枚,其中50例SLN位于胸大肌外侧缘的外侧组淋巴结(LevelⅠ),1例位于胸小肌后(LevelⅡ),1例同时位于LevelⅠ及LevelⅡ,1例同时位于LevelⅠ及胸骨旁。全部病例蓝染料与核素示踪标识的SLN均为同一枚(或同一组)淋巴结,两者完全吻合;且蓝染料注射于乳头乳晕或肿瘤对角线部位与核素注射于肿瘤周围所标识的SLN也完全一致。结论:SLN可能是乳房整个器官的SLN,而非乳房某个具体部位的SLN,与示踪剂的注射部位无关。     

Routine preoperative lymphoscintigraphy is not necessary prior to sentinel node biopsy for breast cancer.

BACKGROUND: This prospective study was performed to ascertain the added benefit of lymphoscintigraphy to a standard method of intraoperative lymphatic mapping and sentinel node biopsy for breast cancer. METHODS: Patients with invasive breast cancer were injected with 99mTc sulfur colloid prior to sentinel node biopsy; preoperative lymphoscintigraphy was then performed in half of the patient population. RESULTS: Sentinel node identification was possible in 45 of 50 patients (90%). All 14 patients (31%) with axillary nodal metastases had at least one histologically positive sentinel node (0% false negative rate). Lymphoscintigraphy revealed sentinel nodes in 17 of the 24 patients (70.8%) imaged. All 17 of these patients had one or more axillary sentinel nodes identified using intraoperative lymphatic mapping. In addition, 5 of 7 patients with a negative preoperative lymphoscintogram had an axillary sentinel lymph node(s) identified intraoperatively. None of the tumors showed drainage to the internal mammary lymph node chain by lymphoscintigraphy despite the fact that there were 5 patients with inner quadrant tumors. There was no significant advantage with respect to sentinel lymph node localization (91.7% versus 88.5%, P = not significant) or false negative rate (0%, both groups, P = not significant) in the group undergoing preoperative lymphoscintigraphy when compared with the patients in whom lymphoscintigraphy was not performed. CONCLUSIONS: Preoperative lymphoscintigraphy adds little additional information to intraoperative lymphatic mapping, and its routine use is not justified.     

Utility of lymphoscintigraphy in directing surgical therapy for melanomas of the head, neck, and upper thorax

Lymphoscintigraphy with technetium99m antimony sulfur colloid or technetium99m human serum albumin helped direct the surgical management of 24 patients who had melanomas of the head, neck, and upper thorax. Eighteen (75%) patients had documented lymphatic flow to other than a single adjacent predictable lymph nodal group. Nineteen patients underwent lymphadenectomy. Availability of the scan altered surgical management in nine patients (47%) who required resection of nodes in addition to resection of adjacent nodes. The discovery of metastatic disease in one patient was clearly attributable to lymphoscintigraphy. This demonstrates the unpredictable lymphatic anatomy of this region and suggests that preoperative lymphoscintigraphy may be useful in directing the surgical management of cutaneous melanomas in which lymph node dissection is planned.     

Reproducibility of lymphoscintigraphic drainage patterns in sequential 99mTc human serum albumin and 99mTc sulfur colloid studies: implications for sentinel node identification in melanoma

BACKGROUND: Selective lymphadenectomy, based on prior lymphatic mapping and sentinel node identification and excision, is now the standard management for intermediate-thickness melanomas in many cancer centers worldwide. At our center 99m-labeled technetium human serum albumin (HSA) scans are performed before the day of surgery in some patients with truncal lesions to detect multiple sites of lymphatic drainage. 99mTc sulfur colloid (SC) is then injected before the operation to delineate the sentinel node(s) for gamma-probe-guided excision. Our purpose was to retrospectively evaluate whether comparable diagnostic information resulted from lymphoscintigraphy performed with these 2 different agents. METHODS: All patients with melanoma who had dual sequential 99mTc HSA and 99mTc SC studies between January 1, 1996, and December 31, 1997, were reviewed. RESULTS: Thirty-eight patients underwent paired HSA and SC imaging. Thirty-two patients had concordant scan findings. In all 6 discordant studies, 2 separate drainage areas were defined by HSA, but only 1 drainage area was defined by SC. CONCLUSIONS: In 15.8% of dual studies (6/38 studies), discordant imaging results were obtained between HSA and SC. SC studies alone may result in nonvisualization of at-risk draining lymph node beds and hence failure to identify and excise all sentinel nodes. This could result in inaccurate staging, inappropriate therapy, and altered prognosis. A reduction in SC dose from 3 to 1 mCi was probably the most significant causal factor leading to these discrepancies, which suggests that the 3-mCi dose is preferable.     

Radiolabeled Sentinel Node Biopsy: Collaborative Trial with the National Cancer Institute

The objective of this study was to maximize the success rate of sentinel node (SN) localization in breast cancer patients with the tracer that demonstrated the highest initial success during a preliminary evaluation. Altogether, 145 patients with operable invasive breast cancer and clinically negative lymph nodes were studied. Technetium 99m (99mTc)-sulfur colloid was injected into the breast parenchyma surrounding the invasive cancer or the biopsy cavity. Variable volumes of tracer, amounts of 99mTc, and duration of time between injection and surgery were evaluated. A hand-held gamma detector was used at surgery to locate and guide resection of all radioactive sentinel nodes (SNs), including those that were extraaxillary. A conventional lymphadenectomy was then performed in all cases. Based on previous studies, unfiltered sulfur colloid provided a higher success rate of SN identification than the other tracer types. Further evaluation with 99mTc-sulfur colloid demonstrated that increased volume increased the success rate of SN identification. An injection volume of 8 ml resulted in a success rate of 98%. SNs were not exclusively located in the axilla: In 8.6% of cases SNs were removed from an internal mammary location. The overall accuracy of patients with SNs resected was 98.4%, and the false-negative rate was 4.4%. It was concluded that (1) unfiltered 99mTc-sulfur colloid at a volume of 8 ml resulted in a high success rate for SN identification; (2) a significant number of the SNs were extraaxillary in location; and (3) the accuracy of the SNs for determining whether regional metastases had occurred was high. The U.S. National Cancer Institute is funding a randomized phase III clinical trial to evaluate SN resection compared to conventional axillary lymphadenectomy in clinical node-negative breast cancer patients. Major endpoints of this trial include long-term regional control and survival.     

Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: results with pathological correlation

PURPOSE: We assessed the sensitivity of preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging the inguinal region of patients with penile cancer and no palpable inguinal adenopathy. MATERIALS AND METHODS: The records of 31 patients with invasive penile cancer and nonpalpable (29) or nonsuspicious (2) inguinal lymph nodes were reviewed. Preoperatively lymphoscintigraphy plus dynamic sentinel node biopsy with (99m)technetium labeled sulfur colloid and isosulfan blue dye was performed in 21 patients and dynamic sentinel node biopsy alone with blue dye only was done in 10. All patients underwent superficial lymph node dissection regardless of preoperative lymphoscintigraphy or dynamic sentinel node biopsy findings to establish pathological nodal status. RESULTS: Six of 32 groins that showed drainage on preoperative lymphoscintigraphy had inguinal node metastasis, as did 1 of 10 that was drainage negative. The sensitivity of preoperative lymphoscintigraphy drainage for cancer detection was 86%. Using dynamic sentinel node biopsy with blue dye plus radiotracer 5 sentinel lymph nodes were positive for cancer, although 2 false-negative results were obtained. Thus, the sensitivity of dynamic sentinel node biopsy per groin for cancer detection was 71%. CONCLUSIONS: In our experience preoperative lymphoscintigraphy and dynamic sentinel node biopsy as currently performed remain insufficient for detecting occult inguinal disease. Superficial lymph node dissection remains the gold standard for detecting inguinal microscopic metastasis in select patients.     

Sentinel node biopsy in vulvar and vaginal melanoma: presentation of six cases and a literature review

Background Urogenital melanoma is a rare neoplasm with poor prognosis. Its management in the past involved radical vulvectomy and complete bilateral inguinofemoral lymphadenectomy. Sentinel lymph node biopsy is an accurate low-morbidity procedure when used in the context of cutaneous melanoma. However, prophylactic lymphadenectomy has not been shown to improve survival of melanoma patients. We wanted to determine the feasibility of sentinel lymph node biopsy in patients with female urogenital melanoma as a staging procedure. Methods Six patients with vulvar or vaginal melanomas underwent preoperative lymphatic mapping with^99mTc-labeled sulfur colloid followed by sentinel lymphadenectomy. In addition, we reviewed the literature on the application of sentinel lymph node biopsy in urogenital tract melanomas. Results One or more sentinel nodes were identified in all six patients by lymphoscintigraphy. All patients underwent sentinel lymphadenectomy, except for one patient with a deep vaginal melanoma that drained to pelvic nodes. The five successful cases had unilateral drainage patterns. None of the sentinel lymph nodes excised had tumor invasion. Combined with five other patients from the published literature, the success rate of localizing sentinel lymph nodes in the patients with urogenital melanoma approaches 100%. Conclusions This experience, plus reports of a small number of patients from three similar studies, supports the impression that sentinel lymph node biopsy is feasible for vulvar and vaginal melanoma.