【摘要】 目的探讨放射性核素定位法探测甲状腺癌前哨淋巴结,并评价前哨淋巴结对甲状腺癌淋巴结转移预测的作用。方法选取2013年3月~2015年4月的甲状腺癌患者中术前均已经穿刺细胞学检查明确诊断的75例DTC患者,临床和影像学检查未发现淋巴结转移和远处转移,无其他恶性肿瘤史及头颈部放疗史,应用99m锝-右旋糖酐(99m-technetium labelled dextran,99mTC-DX)于术前4-6小时在超声引导下注射于甲状腺腺体内。用γ计数器于颈部探测有无放射性浓聚的"热点"术中应用探测仪进行检测SLN(sentinel lym ph node)存在部位;对该部位淋巴组织进行解剖分离;SLN全部被切除后,行颈侧区淋巴结清扫术,所有切除的SLN及NSLN分别送病理检查常规石蜡切片,HE(haem atoxylinand eosin)染色观察其是否有癌转移。其中阴性者采用连续切片和免疫组化的方法进一步分析。结果本组75例患者,SLN检出率为97.3(74/75)。其中SLN阳性者23例,真阴性者50例,假阴性者1例。SLN检测的敏感性为92.0%(23/25),准确性为98.6%(73/74),阴性预测值为98.0%(50/51),假阴性率为4.0%(1/25)。结论 9mTC-DX作为示踪剂可以用来检测甲状腺癌淋巴结转移状态。SLN可以作为甲状腺癌术中淋巴结清扫范围的指标。更多还原

【Abstract】 Objective To investigate the radionuclide localization method detection of thyroid cancer sentinel lymph node, and evaluation of sentinel lymph node of thyroid carcinoma metastasis prediction. Methods A total of 2013 March 2015 April of thyroid cancer patients with preoperative have aspiration cytology diagnosis of 75 cases of DTC patients, clinical and imaging examination found no lymph node metastasis and distant metastasis, to inject 99mTC-DX( 99 mtechnetium labelled dextran) on thyroid gland in preoperative 4-6 hours by ultrasound guide. Using a gamma counter to the neck to detect radioactivity detection in addition to all of the ymph nodes were sent to pathological examination, often gauge paraffin slice, haem atoxylinand eosin staining color. Observe the presence or absence of metastatic carcinoma. Results In the group of 75 patients, SLN detection rate was 97.3(74/75). Of which 23 cases were SLN positive, 50 true negative cases, 1 false negative cases. SLN detection sensitivity was 92.0%(23/25), the accuracy is 98.6%(73/74), negative predictive value was 98.0%(50/51), the false negative rate was 4.0%(1/25). Conclusion 99mTC-DX can be used as a tracer of thyroid cancer lymph node metastasis status detection. SLN can be used as the extent of lymph node dissection for thyroid cancer in the index.更多还原