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目的:通过比较不同示踪剂在非小细胞肺癌(non-small cell lung cancer,NSCLC)前哨淋巴结(sentinel lymph node,SLN)中的应用特点,研究SLN预测早期NSCLC区域淋巴结转移的应用价值。方法:收集我院手术切除的临床Ⅰ期NSCLC患者88例,随机分为4组,术中分别注射亚甲蓝溶液(A组,32例)、纳米碳混悬液(B组,27例)、99锝硫胶体(99 Technetium sulfur colloid,99 TcmSC)溶液(C组,17例)及亚甲蓝联合99 TcmSC(D组,12例),对肺癌SLN进行识别。常规行肺叶切除,将探测到的SLN和纵隔淋巴结分别切除。最终以病理诊断作为标准。结果:A组的SLN检出率为59.4%(19/32);B组为63.0%(17/27);C组为76.5%(13/17)和D组为91.7%(11/12)。D组显著高于前三组,P=0.042。A组SLN预测区域淋巴结转移的准确率、敏感性、阴性预测值和假阴性率分别为89.5%、66.7%、86.7%和10.5%;B组为94.1%、75.0%、92.8%和5.9%;C组为92.3%、80.0%、88.8%和7.7%,D组为100.0%、100.0%、100.0%和0。C组SLN放射性计数值为6208±3206,非SLN为1324±476,差异有统计学意义,P=0.045;D组SLN为6315±3423,非SLN为1438±537,差异有统计学意义,P=0.047。结论:染料和放射性同位素可适用于SLN检测,联合法检测SLN具有更好的可行性。SLN一定程度可反映临床早期NSCLC区域淋巴结的转移状态,有助于提高对区域淋巴结转移的准确预测。
OBJECTIVE: To investigate the value of SLN in predicting lymph node metastasis in early stage of NSCLC by comparing the application characteristics of different tracers in sentinel lymph node (non-small cell lung cancer). Methods: A total of 88 patients with clinical stage Ⅰ NSCLC undergoing surgical resection in our hospital were randomly divided into 4 groups. The patients were injected with methylene blue solution (group A, n = 32), carbon nano suspension (group B, n = 27) , 99 Technetium sulfur colloid (99 TcmSC) solution (group C, 17 cases) and methylene blue combined with 99 TcmSC (group D, 12 cases). Conventional lobectomy, detected SLN and mediastinal lymph nodes were removed. Finally, pathological diagnosis as a standard. Results: The positive rate of SLN was 59.4% (19/32) in group A, 63.0% (17/27) in group B, 76.5% (13/17) in group C and 91.7% (11/12) in group D . D group was significantly higher than the first three groups, P = 0.042. The accuracy, sensitivity, negative predictive value and false-negative rate of SLN predictive region lymph node metastasis in group A were 89.5%, 66.7%, 86.7% and 10.5%, respectively; those in group B were 94.1%, 75.0%, 92.8% and 5.9% respectively. Group C was 92.3%, 80.0%, 88.8% and 7.7%, Group D was 100.0%, 100.0%, 100.0%, and 0 respectively. The counts of SLN in group C were 6208 ± 3206 and 1324 ± 476 in non-SLN, the difference was statistically significant (P = 0.045). The SLN in group D was 6315 ± 3423 and the non-SLN was 1438 ± 537, the difference was statistically significant = 0.047. CONCLUSION: Dyes and radioisotopes are suitable for SLN detection. Combined detection of SLN is more feasible. SLN can reflect the status of lymph node metastasis in early stage of NSCLC to a certain extent, which can help to improve the accurate prediction of regional lymph node metastasis.