| Objective To explore the effective sentinel lymph node(SLN) detection method by using of the preoperative radionuclide imaging method,intraoperative blue dye method and combined method in patients of laryngeal carcinoma.To provide the basis for the treatment of cN0 laryngeal cancer by analysing the SLN distribution.To analyse the clinical values of tumor diagnosis,clinical stage and cervical lymph node metastasis.Methods 41 patients with cN0 laryngeal neoplasms accepted SLN imaging within 16 hour before operation.99Tcm-SC was injected around the tumour with laryngotracheoscopy guided by endoscopic sprinkler pipe.Planar imaging and SPECT-CT imaging were taken at erery 15 minutes after injection until the SLN was visualized.Methylene was injected into the same points where 99Tcm-SC had already been injected and radioactive SLN was detected by using of a handheld gamma-detecting probe during surgery.The results of routine pathologic examination of cervical specimen were set a golden standard to assess the efficacy of SLN biopsy in evaluating the cervical lymph node status.18F-FDG SPECT-CT imaging were given to five patients of laryngeal cancer.And 99Tcm-sc SPECT-CT imaging was also accepted by the fifth patient one day before the surgery.Results The detection rate of SLN were respectively 70.7%,87.8%and 92.7%by blue dye, lymphoscintigraphy and combined methods(P＜0.05).The figures of SLN detected between blue dye and combined methods(P＜0.01),lymphoscintigraphy and combined methods(P＜0.05) were significantly different.However,there was no statistically significant difference between blue dye and lymphoscintigraphy(P＞0.05).SLNs involved in supraglottic,glottic and transgolttic cancer located in the levelsⅡandⅢ.In supraglottic cancinoma SLN localized in levelⅥlymph nodes.The detection rate of SLN were 90.90%(20/22) in supraglottic cancer, among which the detection rates of SLN were respectively 58.97%(23/39) in levelⅢand 41.03%(16/39) in levelⅡ.The detection rate of SLN were 94.12%(16/17) in glottic cancer, among which the detection rates of SLN were respectively 85.71%(18/21) in levelⅢand 14.29%(3/21) in levelⅡ.SLNs were found with metastasis in 9 patients(22.0%).Cases of five patients who took 18F-FDG SPECT-CT imaging,appeared malignant lesions of the larynx.The fifth patient who accepted 99Tcm-SC SPECT-CT imaging appeared metastatic SLN.Conclusions Both SPECT-CT lymphoscintigraphy and methylene blue dye mapping can be used to assess the cervical lymph node status of cN0 laryngeal carcinoma accurately.Combination with both methods is the most efficient and practicable method in SLN detection.It is appropriate to dissectⅢandⅡlevels in supraglottic and glottic.18F-FDG SPECT-CT imaging helps the diagnosis of the laryngeal carcinoma and offers reliable basis of staging and future curing. Objective Know the serum cancer-testis antigen(CTA) family of MAGE-A1, MAGE-A3,NY-ESO-1,SSX-2 and SSX-4 in different stages of laryngeal cancer patients before and after the operation,in order to select the diagnosis of laryngeal cancer serum markers.Through comparison the expression of MAGE-A1,MAGE-A3, NY-ESO-1,SSX-2 and SSX-4 in laryngeal carcinoma and adjacent tissues,analyze relevance of these targets and clinical characteristic of the laryngeal cancer and explore the feasibility of surgical edge.Methods With comparison of squamous cell transformation and differentiation markers(CK-13,CK-19),to detect the pre-operative and post-operative serum content of MAGE-A1,MAGE-A3,NY-ESO-1,SSX-2 and SSX-4 in 25 patients with laryngeal carcinoma,and further detect 46 cases of pre-operative patients with laryngeal carcinoma,35 cases of post-operative patients and 15 cases of normal human serum in the five CTA.By using immunohistochemistry and Western-blot method to detecte the five CTA in laryngeal carcinoma of the central area,adjacent 0.5cm,adjacent 1cm, adjacent 2cm and lymph nodes of 35 patients with laryngeal carcinoma.Results Pre-operative and post-operative Serum content of MAGE-A1,MAGE-A3, NY-ESO-1 and SSX-4 in the 25 cases of patients with laryngeal squamous were significantly different.Among the three groups of pre-operative group,post-operative group and the normal group,serum content of MAGE-A1 and MAGE-A3 in the pre-operative group and the normal group has significant difference.Serum content of NY-ESO-1 were significant different in these groups.The serum content of SSX-4 both in pre-operative group,normal group and post-operative group,normal group is significant different.The expression levels of seven kinds of CTA protein were found significantly decreased by turns in laryngeal carcinoma of the central area,adjacent 0.5cm,adjacent 1cm,adjacent 2cm,while the expression levels of CK-13 and CK-19 of the central area of cancer is higher than adjacent 0.5cm,the difference was not significant.Conclusions MAGE-A1 and MAGE-A3 could become the the serum markers to diagnose the laryngeal squamous cell carcinoma and predict the recurrence,while NY-ESO-1 become the the serum markers to diagnose the laryngeal squamous cell carcinoma and predict the early recurrence.MAGE-A1,MAGE-A3,NY-ESO-1, SSX-2 and SSX-4 in laryngeal squamous cell carcinoma has a higher expression rate. And more than 0.5cm away from the edge of tumor of laryngeal squamous cell carcinoma are relatively safe.
|
PDF Full Text Request