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題 名 | 口腔鱗狀細胞癌患者前哨淋巴結偵測與頸部淋巴轉移分析=Analysis of Sentinel Lymph Node Detection and Biopsy for Patients with Oral Squamous Cell Carcinoma |
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作 者 | 孫章唐; 謝天渝; 陳俊明; 陳毓雯; 陳中和; | 書刊名 | 中華民國口腔顎面外科學會雜誌 |
卷 期 | 18:1 2007.03[民96.03] |
頁 次 | 頁1-8 |
分類號 | 416.94 |
關鍵詞 | 口腔鱗狀細胞癌; 前哨淋巴結; 淋巴閃爍造影; Oral squamous cell carcinoma; Sentinel lymph node; Lymphoscintigraphy; |
語 文 | 中文(Chinese) |
中文摘要 | 臨床上對口腔鱗狀細胞癌患者頸部淋巴結觸診與電腦斷層或磁振造影檢查是決定術前分期的重要方式,但淋巴結潛伏轉移無法有明確發現方法一直是大家所關心的問題。因為口腔鱗狀細胞癌患者頸部淋巴結轉移與否是患者治療之重要預後因子,及決定要進行何種範圍的頸部淋巴廓清術,也是病患術後生活品質的重要指標。針對前哨淋巴結偵測之理論已廣泛運用於評估及治療黑色素瘤及乳癌病患,因而希望此方法也是解決口腔鱗狀細胞癌患者頸部淋巴結轉移檢查之可能方式。本研究以2004年3月至8月間高雄醫學大學附設醫院口腔顎面外科治療的病人為研究對象收集資料予以統計分析。計有16位診斷為口腔鱗狀細胞癌男性病患同意接受研究。病患在手術前除接受頭頸部電腦斷層掃描攝影檢查外併接受口腔原發病灶區週邊注射鎝99m硫化膠體放射藥劑進行淋巴閃爍造影。16位患者均接受口腔原發病灶廣泛性切除併頸部肩胛舌骨肌上淋巴廓清手術,術中及術後以病理診斷報告作為依據分析評估電腦斷層掃描攝影與前哨淋巴結影像之結果。本實驗發現以核子醫學偵測前哨淋巴結之偵測率為68.75%,其確診率為56.25%。根據研究結果前哨淋巴結偵測及手術切片協助確認臨床分期決定頸部淋巴廓清術範圍之可信賴模式仍待更多資料方能建立。 |
英文摘要 | Clinically we used physical examination as neck lymph node palpation, CT scan or MRI in patients with oral squamous cell carcinoma (OSCC), because the presence of lymph node metastases is the most important prognosticator. Sentinel lymph node (SLN) biopsy has been shown to be an accurate staging technique for patients with breast cancer and melanoma and might also be suited for patients with OSCC. This study was undertaken to determine whether the SN concept holds true for OSCC and could be exploited for SLN biopsy. The study was carried out in Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital between 2004 March~August. We collected 16 patients who received lymphoscintigraphy after administration of radionuclide Technetium 99m. In 16 patients were classification with T1 to T4 and N0 or N1 oral squamous cell carcinoma who were scheduled to undergo combined primary tumor excision and supraomohyoid neck dissection, SLN identification was performed the day before surgery by use of lymphoscintigraphy after peritumoral injections of 99mTc-labeled colloidal albumin. Overall, in 11 (68.75%) of 16 neck sides, one or two SLNs were mostly identified by scintigraphy. Of the five neck sides in which SLNs were not identified by scintigraphy. Total 16 patients received neck dissection and the neck dissection specimens were removed. Then specimens were retrieved for histopathologic analysis, including SLNs were for serial sectioning. At histologic examination of the 11 neck specimens in which the SLN was found, at least one SLN was tumor positive in 4 cases. Our study found the over-all accuracy of the SLN procedure for predicting the presence or absence of lymph node metastases in the neck was 56.25% (9 of 16 neck specimens). Based on our preliminary observation of the patients we have found the fact that sentinel node detection and biopsy may be reliable for the whole neck lymphatic system. Although the role of SLN biopsy in the management of the neck lymph node metastases in these patients has yet to be established the acceptable model through prospective trials. The patients are still followed up and further clinical observations are needed based on a larger number of patients and longer observation period. |
本系統中英文摘要資訊取自各篇刊載內容。