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目的探讨结直肠癌前哨淋巴结(SLN)体外定位技术方法及其可行性、准确性和临床价值。方法选择2003年3月至2003年10月间中山大学肿瘤防治中心腹科住院行根治手术的结直肠癌患者60例,62个肿瘤(2例患者为多原发),进行体外SLN定位。标本离体后尽早进行异硫蓝SLN定位,传统病理检查阴性的SLN进行细胞角蛋白免疫组化检查。结果62例肿瘤成功检出SLN的59例,检出率95.2%。59例患者总共获得并检测1114枚淋巴结,平均每人18.9(4~46)枚。其中SLN157枚(14.9%),平均每人2.7(1~9)枚。SLN敏感性39.1%(9/23),假阴性率23.7%(14/59),准确率76.3%(45/59)。50例SLN阴性的中有12例(24%)细胞角蛋白免疫组化检测阳性。36例HE和细胞角蛋白免疫组化检查全阴性者中4例(11.1%)SLN发现微转移灶。14例仅非SLN阳性中8例SLN发现微转移灶。结论结直肠癌异硫蓝SLN体外定位活检技术是可行的,结合免疫组化检测微转移可以提高术后分期,可以提高送检淋巴结个数,结合免疫组化技术,可以减少淋巴结转移漏诊发生率。但该方法假阴性率较高,不能完全取代常规淋巴结病理检查。
Objective To investigate the method of localization of sentinel lymph node (SLN) in colorectal cancer and its feasibility, accuracy and clinical value. METHODS: From March 2003 to October 2003, 60 patients with colorectal cancer who underwent radical surgery in Sun Yat-sen University Cancer Center, 62 patients with tumors (2 patients with multiple primary) underwent radical in situ SLN localization. The specimens were subjected to isothiocyanate SLN localization as soon as possible after ex vivo and the conventional pathology negative SLN for cytokeratin immunohistochemistry. Results Of the 62 cases, 59 cases of SLN were successfully detected, the detection rate was 95.2%. A total of 1114 lymph nodes were obtained and detected in 59 patients, averaging 18.9 (4 to 46) per person. Of which SLN157 (14.9%), an average of 2.7 (1 ~ 9) pieces. The sensitivity of SLN was 39.1% (9/23), the false negative rate was 23.7% (14/59) and the accuracy was 76.3% (45/59). Twelve out of 50 SLN negatives (24%) were positive for cytokeratin immunohistochemistry. Micrometastases were found in SLN of 4 cases (11.1%) in 36 cases with HE and cytokeratin immunohistochemistry. Micrometastases were found in 8 out of 14 SLN-positive SLNs. Conclusion In situ biopsy of isosulfan blue thyroid cancer with colorectal cancer is feasible. Combined with immunohistochemical detection of micrometastasis, it can improve the postoperative staging, increase the number of lymph nodes examined, and reduce the incidence of missed diagnosis of lymph node metastasis by immunohistochemistry . However, this method has a high false negative rate and can not completely replace the routine pathological examination of lymph nodes.