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首页> 外文期刊>Saudi Journal of Gastroenterology >Role of intraoperative sentinel lymph node mapping in the management of carcinoma of the esophagus
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Role of intraoperative sentinel lymph node mapping in the management of carcinoma of the esophagus

机译：术中前哨淋巴结定位在食管癌治疗中的作用

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Background/Aim: Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. This study aims to investigate the feasibility and accuracy of detection of SLN using methylene blue dye in patients with carcinoma of the esophagus and assess its potential role in determining the rational extent of lymphadenectomy in esophageal cancer surgery. Materials and Methods: Thirty-two patients of esophageal cancer diagnosed on endoscopic biopsy were enrolled in this prospective study. After laparotomy, patent methylene blue was injected into the subserosal layer adjacent to the tumor. SLNs were defined as blue stained nodes within a period of 5 min. Standard radical esophagogastrectomy with lymphadenectomy was performed in all the patients. All the resected nodes were examined postoperatively by routine hematoxylin and eosin stain for elucidating the presence of metastasis, and the negative SLNs were examined further with cytokeratin immunohistochemical staining. Results: SLNs were detected in 26 (81.25%) patients out of 32 patients who were studied. The number of SLNs ranged from 1 to 4 with a mean value of 1.7 per case. The SLNs of esophageal cancer were only found in N1 area in 21 (80.77%) cases, and in N2 or N3 area in only 19.33%. The overall accuracy of the procedure was 75% in predicting nodal metastasis. SLN had a sensitivity of 85.71% in mid esophageal tumors and 93.33% in lower esophageal tumors. The SLN biopsy had sensitivity of 87.5% in the case of squamous cell carcinoma and 92.86% in the cases of adenocarcinoma of the esophagus. The accuracy of the procedure for squamous cell carcinoma and adenocarcinoma was 60% and 76.47%, respectively. Conclusion: SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with esophageal cancer and may indicate rational extent of lymphadenectomy in these patients. SLN mapping provides "right nodes" to the pathologists for detailed analysis and appropriate staging, thereby helping in individualizing the multi-modal treatment for esophageal cancer.
机译：背景/目的：准确评估淋巴结状态是确定治疗胃肠道（GI）临床结果的最重要因素之一。前哨淋巴结（SLN）映射显然已成为分期胃肠癌的高度可行和准确的方法。本研究旨在探讨使用亚甲基蓝染料检测食管癌患者SLN的可行性和准确性，并评估其在确定食管癌手术中进行淋巴结清扫术合理范围方面的潜在作用。材料与方法：这项前瞻性研究纳入了32例经内镜活检诊断为食道癌的患者。开腹手术后，将亚甲蓝漆注射到邻近肿瘤的浆膜下层。 SLN被定义为在5分钟内染成蓝色的节点。所有患者均行标准的根治性食管胃切除术与淋巴结清扫术。术后所有常规切除的淋巴结均用苏木精和曙红染色检查，以检查是否有转移，并用细胞角蛋白免疫组化染色进一步检查阴性的SLN。结果：在研究的32例患者中，有26例（81.25％）患者检测到SLN。 SLN的数量范围为1至4，每例的平均值为1.7。食管癌的SLN仅在N1区发现21例（80.77％），在N2或N3区仅发现19.33％。该程序在预测淋巴结转移方面的总体准确性为75％。 SLN在食管中段肿瘤中的敏感性为85.71％，在食管下段肿瘤中的敏感性为93.33％。对于鳞状细胞癌，SLN活检的敏感性为87.5％，对于食道腺癌，SLN活检的敏感性为92.86％。鳞状细胞癌和腺癌的手术准确率分别为60％和76.47％。结论：SLN定位是检测食管癌患者淋巴结转移的准确诊断方法，可能表明这些患者进行了正确的淋巴结清扫术。 SLN映射为病理学家提供了“正确的节点”，以进行详细的分析和适当的分期，从而帮助个性化食道癌的多模式治疗。

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