目的评估完全磁方法在口腔癌患者前哨淋巴结活检(SLNB)手术中的可行性和优点。
这项研究包括10名口腔癌患者(cT1-T2N0M0期),计划进行选择性颈淋巴结清扫术(END)。超顺磁性氧化铁纳米颗粒(SPIO)在手术前瘤周给药。获得术前MRI以识别具有铁摄取的淋巴结(LN)。之前使用磁性检测器来识别磁性热点,during,并且在SLNB过程之后。切除的前哨LN(SLN)使用分步连续切片进行评估,并对颈淋巴结清扫标本进行常规组织病理学检查。获得术后MRI以观察任何残留的铁。
在十个原发性肿瘤中,八个位于舌头上,一口地板(FOM),和一个舌头-FOM过渡。9名患者经历了SPIO注射的痛苦,其中两个人出现了舌头肿胀。在八个病人中,在磁性SLNB过程中成功检测并切除了磁性SLN。在END过程中,在3例患者中发现了额外的磁性SLN.组织病理学证实了切除的SLN的鼻窦中铁沉积。三个SLN有转移,其中一个仅在END过程中被识别。END标本显示没有进一步的转移。
10例患者中有8例成功进行了完整的磁性SLNB手术(成功率为80%),因此这个程序似乎是可行的。建议进行进一步调查,包括:使用麻醉药,磁性示踪体积,术前计划MRI,与传统技术的比较和随访。
To assess the feasibility and merits of a complete magnetic approach for a sentinel lymph node biopsy (SLNB) procedure in oral cancer patients.
This
study included ten oral cancer patients (stage cT1-T2N0M0) scheduled for elective neck dissection (END). Superparamagnetic iron oxide nanoparticles (SPIO) were administered peritumorally prior to surgery. A preoperative MRI was acquired to identify lymph nodes (LNs) with iron uptake. A magnetic detector was used to identify magnetic hotspots prior, during, and after the SLNB procedure. The resected sentinel LNs (SLNs) were evaluated using step-serial sectioning, and the neck dissection specimen was assessed by routine histopathological examination. A postoperative MRI was acquired to observe any residual iron.
Of ten primary tumors, eight were located in the tongue, one floor-of-mouth (FOM), and one tongue-FOM transition. SPIO injections were experienced as painful by nine patients, two of whom developed a tongue swelling. In eight patients, magnetic SLNs were successfully detected and excised during the magnetic SLNB procedure. During the END procedure, additional magnetic SLNs were identified in three patients. Histopathology confirmed iron deposits in sinuses of excised SLNs. Three SLNs were harboring metastases, of which one was identified only during the END procedure. The END specimens revealed no further metastases.
A complete magnetic SLNB procedure was successfully performed in eight of ten patients (80% success rate), therefore the procedure seems feasible. Recommendations for further investigation are made including: use of anesthetics, magnetic tracer volume, planning preoperative MRI, comparison to conventional technique and follow-up.