放射線定位前哨淋巴結在口腔癌頸部淋巴轉移之應用

Evaluation of Neck Metastasis Using Radiolocalization of Sentinel Lymph Nodes for Oral Cavity Carcinoma

曾憲彰(Hsian-Chang Tseng) ； 蔡銘修(Ming-Hsui Tsai) ； 花俊宏(Chun-Hung Hua) ； 高嘉鴻(Chia-Hung Kao) ； 林智一(Tze-Yi Lin)

《台灣耳鼻喉頭頸外科雜誌》 39卷5期 (2004/11) Pp. 190-198

https://doi.org/10.6286/2004.39.5.190

摘要

背景：頸部淋巴轉移是口腔癌很重要的預後因子，臨床上經理學檢查及影像學檢查皆無頸部淋巴轉移迹象之N0口腔癌患者，仍有發生頸部潛伏性轉移(occult metastasis)的機會，進而影響後續治療。因此如何準確診斷頸部潜伏性轉移遂成爲研究發展的方向。而本研究是針對臨床診斷爲 N0的口腔癌患者，藉由放射線定位原發腫瘤處淋巴引流最先到達的前哨淋巴結(sentinel lymph node)，評估前哨淋巴結在診斷頸部淋巴潛伏性轉移之可行性及準確性。
方法：自2003年6月至同年9月間，因口腔扁平上皮癌經理學檢查及電腦斷層掃描，臨床診斷爲N0的口腔癌病患，在接受全身麻醉下於腫瘤周圍注射放射線鎝元素試劑(Technetium 99m sulfur colloid)，藉由放射線導引定位系統Navigator Gamma Guidance system (Auto Suture Co, Norwalk, Connecticut)於施行肩胛舌骨上頸部廓清術前先定位取出前哨淋巴結，並將取出之前哨淋巴結與肩胛舌骨上頸部廓清術之檢體分別送病理檢查。將偵測到前哨淋巴結的位置、放射線強度、前哨淋巴結與肩胛舌骨上頸部廓清術檢體之病理報告加以統計分析。
結果：共有14名臨床診斷爲N0口腔癌患者完成研究，藉由放射線定位，14名病患皆能成功找出相對應之前哨淋巴結，平均每名病患可定位取出2.4個前哨淋巴結。經組織病理學檢查顯示在14名病患中有12名病患(8.57%)其前哨淋巴結與肩胛舌骨上頸部廓清術檢體皆無癌細胞轉移，其頸部潛伏性轉移之陰性預測值(negative predictive value)為100%。在14名病患中有2名病患(14.3%)發生頸部潛伏性轉移，經組織病理學檢驗發現其癌細胞轉移皆僅出現在放射線定位之前哨淋巴結。
結論：本研究中前哨淋巴結病理檢查未有癌細胞轉移者其肩胛舌骨上頸部廓清術檢體也皆未發現有癌細胞轉移，顯示出放射線定位之前哨淋巴結能確實反映頸部淋巴潜伏性轉移之情况。經文獻回顧，就目前在口腔癌頸部淋巴潜伏性轉移評估之應用，以放射線定位前哨淋巴結，可提供較高的準確性及可行性。而更長期的成效及是否可做爲臨床診斷N0口腔癌患者施行頸部廓清術的參考依據，則仍需持續評估。

關鍵字

前哨淋巴結 ； 口腔癌 ； 潛伏性轉移

並列摘要

BACKGROUND: For patients with oral cavity carcinoma, neck lymph node metastasis represents the most important prognostic factor. Even in patients without any clinical or radiological evidence of neck lymph node metastasis (clinically N0 neck), there is still a significant rate of occult metastases. Thus, accurate identification of occult metastases is important regarding elective treatment modalities in the clinically N0 neck of patients with oral cavity carcinoma. The aims of our study were to assess the feasibility of radiolocalization of sentinel lymph nodes and the predictive value for occult metastases in the clinically N0 neck of patients with oral cavity carcinoma.
METHODS: Between June and September 2003, patients with histopathologically confirmed squamous cell carcinoma of the oral cavity and clinically staged N0 neck were eligible for our prospective study. After injection of Technetium 99m sulfur colloid in the circumference of the primary tumor under general anesthesia, detection and excisional biopsy of radiolabeled sentinel lymph nodes were performed with the aid of Navigator Gamma Guidance System (Auto Suture Co, Norwalk, Connecticut), the patients then received elective neck dissection. Subsequently, radiolabeled sentinel lymph nodes and the neck dissection specimens were sent separately for histopathological analysis. The presence of occult metastases in radiolabeled sentinel lymph nodes and the neck dissection specimens, locations and gamma counts of radio labeled sentinel lymph nodes were analyzed.
RESULTS: Fourteen patients with clinical N0 oral cavity carcinoma were prospectively enrolled into the study. For each of the 14 patients, the sentinel lymph nodes were successfully localized with radiolocalization technique and then excised. On the average, 2.4 sentinel lymph nodes were identified in each patient. In 12 of the 14 patients (85.7%), there were no histopathological positive nodes among radiolabeled sentinel lymph nodes and the neck dissection specimens, the negative predictive value for detecting occult metastases was 100 %. Two of the 14 patients (4.3%) demonstrated occult metastases on histopathological analysis; in each instance, the radiolabeled sentinel lymph nodes represented the only histopathological positive nodes. CONCLUSION: In our study, there was no instance in which radiolabeled sentinel lymph nodes were negative for metastatic tumor cells while being positive in the neck dissection specimens. The status of radiolabeled sentinel lymph nodes is able to
accurately reflect the presence of neck occult metastases. According to a variety of evaluations of neck occult metastases in the patients with oral cavity carcinoma, radiolocalization of the sentinel lymph nodes is more feasible and highly accurate. To determine whether this approach is as a selection criterion to perform neck dissection in the clinically N0 neck of patients with oral cavity carcinoma, further investigation and long term follow-up of this approach are warranted.

並列關鍵字

sentinel lymph node ； oral cavity carcinoma ； occult metastasis