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目的探讨早期宫颈癌患者前哨淋巴结(SLN)检测的快速术中诊断方法和临床价值。方法采用联合放射性同位素和蓝染法对30例早期宫颈癌患者行 SLN 检测,按 FIGO 分期,30例患者中ⅠB1期14例,ⅡA期16例。于术前在宫颈3′、6′、9′、12′各注射~(99m)Tc-硫胶体0.4 mci/0.4 ml,开腹后在宫颈4个相同部位注射亚甲蓝各1 ml,术中识别 SLN,即蓝染淋巴结和/或热点淋巴结,并原位切除 SLN,然后行经腹广泛子宫切除+盆腔淋巴切除术。术中行印片细胞学和快速冰冻检查以检测SLN 是否转移,比较 SLN 术中印片细胞学及快速冰冻检查和 HE 染色检查结果。结果30例患者中29例检出 SLN,检出率为96.7%,HE 检查示盆腔淋巴结转移者9例。检出 SLN 的29例中8例 SLN阳性,20例 SLN 阴性,1例 SLN 假阴性。SLN 检测的灵敏性为88.9%、准确性为96.6%,假阴性率为11.1%。SLN 术中快速冰冻和印片细胞学检查的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为92.3%、100%、98.9%、100%、98.8%和92.3%、97.6%、96.8%、85.7%、98.8%。结论冰冻切片和印片细胞学病理检查是术中快速诊断 SLN 转移状态的可选择方法;SLN 检测对宫颈癌盆腔淋巴结转移具有预测性。
Objective To investigate the rapid intraoperative diagnosis and clinical value of sentinel lymph node (SLN) detection in patients with early cervical cancer. Methods SLN was detected in 30 cases of early stage cervical cancer by radioisotope and blue dye method. According to FIGO staging, 14 cases were stage IB1 and 16 cases were stage IIA in 30 cases. (99m) Tc-sulfur colloid 0.4 mci / 0.4 ml was injected into the cervix 3 ’, 6’, 9 ’, 12’ before surgery and 1 ml of methylene blue was injected into the same part of the cervix after laparotomy SLNs are identified, ie, blue-stained lymph nodes and / or hot-stained lymph nodes, and SLNs are resected in situ and then extensive abdominal hysterectomy + pelvic lymphadectomy. Intraoperative line printing cytology and rapid frozen check to detect SLN metastasis, SLN surgery comparing cytology and rapid freezing test and HE staining test results. Results The SLN was detected in 29 out of 30 patients. The detection rate was 96.7%. There were 9 cases of pelvic lymph node metastasis by HE. Of the 29 cases with SLN detected, 8 were SLN positive, 20 were SLN negative and 1 was SLN false negative. The sensitivity of SLN was 88.9%, the accuracy was 96.6% and the false negative rate was 11.1%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SLN were 92.3%, 100%, 98.9%, 100%, 98.8% and 92.3%, 97.6% , 96.8%, 85.7%, 98.8%. Conclusion Frozen sections and histopathological examination of imprinted cells are an effective method for rapid diagnosis of SLN metastasis during operation. SLN detection is predictive of pelvic lymph node metastasis of cervical cancer.