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目的探讨荧光法在示踪c N0期甲状腺乳头状癌患者前哨淋巴结(SLN)中的应用价值。方法收集2015年1月至2016年1月期间在笔者所在医院住院治疗的c T1~3N0M0甲状腺乳头状癌患者共40例,用吲哚菁绿(ICG)作为荧光示踪剂,通过术中冰冻病理学检查及术后石蜡病理学检查,观察并检出SLN,分析ICG示踪SLN的作用和前哨淋巴结活检(SLNB)对颈部中央区淋巴结清扫的指导作用。结果 40例甲状腺癌患者均行SLNB后再做中央区淋巴结清扫,有37例检出SLN,其检出率为92.5%(37/40),共检出SLN 98枚,1~5枚/例,平均2.65枚/例。术中冰冻病理学检查示28例患者SLN有癌转移,9例患者SLN无癌转移,其中有1例术中检测SLN无癌转移的患者,术后石蜡病理学检查检测出微转移,其余8例术后病理学检查结果提示中央区淋巴结未见癌转移。3例未检出SLN者中央区淋巴结无癌转移。ICG荧光示踪法行SLNB的灵敏度为96.6%(28/29),假阴性率为3.45%(1/29)。结论荧光示踪法检测甲状腺癌的SLN,具有检出率高及灵敏度高的优势,能较为准确地对c N0期甲状腺癌患者的颈部中央区淋巴结清扫进行指导。
Objective To investigate the value of fluorescence method in the detection of sentinel lymph node (SLN) in patients with papillary thyroid carcinoma at stage c N0. Methods A total of 40 patients with c T1 ~ 3N0M0 thyroid papillary carcinoma hospitalized in the author’s hospital from January 2015 to January 2016 were enrolled in this study. Indocyanine green (ICG) was used as a fluorescent tracer and intraoperative frozen Pathological examination and postoperative paraffin pathological examination, observed and detected SLN, ICG tracer SLN analysis of the role and sentinel lymph node biopsy (SLNB) in the central lymph node dissection of the guidance role. Results Thirty patients with thyroid cancer underwent central lymph node dissection after performing SLNB, and 37 cases were detected with SLN. The detection rate was 92.5% (37/40). A total of 98 SLNs were detected, 1 to 5 , An average of 2.65 pieces / case. Intraoperative frozen pathological examination showed that 28 cases of SLN cancer metastasis, 9 cases of SLN no cancer metastasis, including 1 case of intraoperative SLN no cancer metastasis in patients with postoperative paraffin pathological examination detected micrometastasis, the remaining 8 Cases of postoperative pathological findings suggest no lymph node metastasis in the central area. Three cases of SLN were not detected in the central lymph node metastasis. The sensitivity of SLNB was 96.6% (28/29) and the false negative rate was 3.45% (1/29) with ICG fluorescent tracing. Conclusion Fluorescent tracer detection of thyroid cancer SLN has the advantages of high detection rate and high sensitivity, which can accurately guide the lymph node dissection in patients with c N0 stage thyroid cancer.