M. Kotov, Z. Radzhabova, S. Novikov, P. Krzhivitsky, O. Ponomareva, E. Kostromina, V. Kushnarev, M. A. Radzhabova
{"title":"口腔舌鳞状细胞癌cT1-2N0前哨淋巴结活检:前瞻性单中心研究","authors":"M. Kotov, Z. Radzhabova, S. Novikov, P. Krzhivitsky, O. Ponomareva, E. Kostromina, V. Kushnarev, M. A. Radzhabova","doi":"10.17650/2222-1468-2020-10-1-84-92","DOIUrl":null,"url":null,"abstract":"The study objectiveis to evaluate the informativeness of the biopsy technique of the signal lymph node (LN) in squamous cell carcinoma of the tongue cT1–2N0.Materials and methods.A prospective, single-center study included 26 patients with morphologically verified squamous cell carcinoma of the tongue cT1–2 and the lack of clinical and radiological data for metastatic damage to the LNs of the neck. All patients underwent a radioisotope study of the lymphatic flow from the primary tumor and the topography of the signal LNs. The informativeness of the biopsy of the signal LNs was evaluated in accordance with 2 diagnostic models. When using the first diagnostic model, all LNs accumulating colloids labeled with the 99mTc isotope were considered signal LNs. In the second model, only nodes accumulating radiocolloids and located in the immediate vicinity of the primary tumor of the tongue and / or connected with the primary tumor by the “pathway” of the lymphatic vessels were considered as signal LNs.Results.The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy, according to the 1st diagnostic model, were 66.6 % (95 % confidence interval (CI) 9.43–99.16), 100 % (95 % CI 85.18–100 %), 100 %, 95.83 % (95 % CI 82.28–99.13 %), 96.15 % (95 % CI 80.36–99.90 %), and when all LNs located along with the signal LNs were removed at the same levels as regional LNs, the sensitivity increased to 100 %. In the second model, the diagnostic values were: 33.3 % (95 % CI 0.84–90.57), 100 % (95 % CI 85.18– 100.00), 100 %, 92 % (95 % CI 83.78–96.24), 92.31 % (95 % CI 74.87–99.05 %).Conclusion.Evaluation of lymphatic outflow from the primary tumor and assessment of sentinel lymph node location in patients with stage cT1–2N0M0 squamous cell carcinoma of the tongue allow a doctor to determine the volume of lymph node dissection for each patient individually. Unilateral lymph node dissection is acceptable in patients with unilateral lymphatic outflow, whereas in patients with bilateral lymphatic outflow, it is associated with a quite high (up to 10 %) risk of metastatic lesions in the lymph nodes on the opposite side of the neck. It is necessary to excise all lymph nodes accumulating radiocontrast agent and regional lymph nodes located at the same levels. ","PeriodicalId":36598,"journal":{"name":"Opuholi Golovy i Sei","volume":"1 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2020-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sentinel lymph node biopsy for oral tongue squamous cell carcinoma cT1–2N0: prospective single-center study\",\"authors\":\"M. Kotov, Z. Radzhabova, S. Novikov, P. Krzhivitsky, O. Ponomareva, E. Kostromina, V. Kushnarev, M. A. Radzhabova\",\"doi\":\"10.17650/2222-1468-2020-10-1-84-92\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"The study objectiveis to evaluate the informativeness of the biopsy technique of the signal lymph node (LN) in squamous cell carcinoma of the tongue cT1–2N0.Materials and methods.A prospective, single-center study included 26 patients with morphologically verified squamous cell carcinoma of the tongue cT1–2 and the lack of clinical and radiological data for metastatic damage to the LNs of the neck. All patients underwent a radioisotope study of the lymphatic flow from the primary tumor and the topography of the signal LNs. The informativeness of the biopsy of the signal LNs was evaluated in accordance with 2 diagnostic models. When using the first diagnostic model, all LNs accumulating colloids labeled with the 99mTc isotope were considered signal LNs. In the second model, only nodes accumulating radiocolloids and located in the immediate vicinity of the primary tumor of the tongue and / or connected with the primary tumor by the “pathway” of the lymphatic vessels were considered as signal LNs.Results.The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy, according to the 1st diagnostic model, were 66.6 % (95 % confidence interval (CI) 9.43–99.16), 100 % (95 % CI 85.18–100 %), 100 %, 95.83 % (95 % CI 82.28–99.13 %), 96.15 % (95 % CI 80.36–99.90 %), and when all LNs located along with the signal LNs were removed at the same levels as regional LNs, the sensitivity increased to 100 %. In the second model, the diagnostic values were: 33.3 % (95 % CI 0.84–90.57), 100 % (95 % CI 85.18– 100.00), 100 %, 92 % (95 % CI 83.78–96.24), 92.31 % (95 % CI 74.87–99.05 %).Conclusion.Evaluation of lymphatic outflow from the primary tumor and assessment of sentinel lymph node location in patients with stage cT1–2N0M0 squamous cell carcinoma of the tongue allow a doctor to determine the volume of lymph node dissection for each patient individually. Unilateral lymph node dissection is acceptable in patients with unilateral lymphatic outflow, whereas in patients with bilateral lymphatic outflow, it is associated with a quite high (up to 10 %) risk of metastatic lesions in the lymph nodes on the opposite side of the neck. It is necessary to excise all lymph nodes accumulating radiocontrast agent and regional lymph nodes located at the same levels. \",\"PeriodicalId\":36598,\"journal\":{\"name\":\"Opuholi Golovy i Sei\",\"volume\":\"1 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-04-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Opuholi Golovy i Sei\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.17650/2222-1468-2020-10-1-84-92\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Opuholi Golovy i Sei","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17650/2222-1468-2020-10-1-84-92","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
本研究的目的是评价舌鳞癌cT1-2N0信号淋巴结活检技术的信息价值。材料和方法。一项前瞻性、单中心研究纳入了26例形态学证实的舌鳞癌cT1-2患者,缺乏颈部淋巴结转移损伤的临床和影像学资料。所有患者都接受了原发肿瘤淋巴血流和信号LNs地形的放射性同位素研究。根据两种诊断模型评估活检信号LNs的信息量。当使用第一种诊断模型时,所有以99mTc同位素标记的聚集胶体都被认为是信号LNs。结果第一种诊断模型的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为66.6%(95%置信区间(CI) 9.43 ~ 99.16)、100% (95% CI 85.18 ~ 100%)、100% (95% CI 85.18 ~ 100%)、100% (95% CI 85.18 ~ 100%)、100% (95% CI 85.18 ~ 100%)。95.83% (95% CI 82.28 - 99.13%), 96.15% (95% CI 80.36 - 99.90%),当所有与信号LNs一起定位的LNs都以与区域LNs相同的水平去除时,灵敏度增加到100%。第二种模型的诊断值分别为33.3% (95% CI 0.84 ~ 90.57)、100% (95% CI 85.18 ~ 100.00)、100%、92% (95% CI 83.78 ~ 96.24)、92.31% (95% CI 74.87 ~ 99.05%)。cT1-2N0M0期舌鳞癌患者原发肿瘤淋巴流出量的评估和前哨淋巴结位置的评估使医生能够确定每个患者单独淋巴结清扫的体积。单侧淋巴流出患者可以接受单侧淋巴结清扫,而双侧淋巴流出患者则有相当高(高达10%)的颈部对侧淋巴结转移病变风险。有必要切除所有积聚放射造影剂的淋巴结和位于同一水平的区域淋巴结。
Sentinel lymph node biopsy for oral tongue squamous cell carcinoma cT1–2N0: prospective single-center study
The study objectiveis to evaluate the informativeness of the biopsy technique of the signal lymph node (LN) in squamous cell carcinoma of the tongue cT1–2N0.Materials and methods.A prospective, single-center study included 26 patients with morphologically verified squamous cell carcinoma of the tongue cT1–2 and the lack of clinical and radiological data for metastatic damage to the LNs of the neck. All patients underwent a radioisotope study of the lymphatic flow from the primary tumor and the topography of the signal LNs. The informativeness of the biopsy of the signal LNs was evaluated in accordance with 2 diagnostic models. When using the first diagnostic model, all LNs accumulating colloids labeled with the 99mTc isotope were considered signal LNs. In the second model, only nodes accumulating radiocolloids and located in the immediate vicinity of the primary tumor of the tongue and / or connected with the primary tumor by the “pathway” of the lymphatic vessels were considered as signal LNs.Results.The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy, according to the 1st diagnostic model, were 66.6 % (95 % confidence interval (CI) 9.43–99.16), 100 % (95 % CI 85.18–100 %), 100 %, 95.83 % (95 % CI 82.28–99.13 %), 96.15 % (95 % CI 80.36–99.90 %), and when all LNs located along with the signal LNs were removed at the same levels as regional LNs, the sensitivity increased to 100 %. In the second model, the diagnostic values were: 33.3 % (95 % CI 0.84–90.57), 100 % (95 % CI 85.18– 100.00), 100 %, 92 % (95 % CI 83.78–96.24), 92.31 % (95 % CI 74.87–99.05 %).Conclusion.Evaluation of lymphatic outflow from the primary tumor and assessment of sentinel lymph node location in patients with stage cT1–2N0M0 squamous cell carcinoma of the tongue allow a doctor to determine the volume of lymph node dissection for each patient individually. Unilateral lymph node dissection is acceptable in patients with unilateral lymphatic outflow, whereas in patients with bilateral lymphatic outflow, it is associated with a quite high (up to 10 %) risk of metastatic lesions in the lymph nodes on the opposite side of the neck. It is necessary to excise all lymph nodes accumulating radiocontrast agent and regional lymph nodes located at the same levels.