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SPECT-CT探测喉癌前哨淋巴结 总被引:11,自引:0,他引:11
目的 评价SPECT-CT淋巴显像探测喉癌患者前哨淋巴结(SLN)的价值。方法 30例临床N0期喉癌患者,术前于喉镜引导下注射99Tcm-硫胶体(SC),使用SPECT-CT进行SLN显像;同时,术中用γ探测仪探测放射性"热点"。将手术切除的SLN及颈清扫标本行病理检查。结果 全组30例检出SLN28例,检出率为93.3%。术前平面显像、SPECT-CT分别检出61个和66个SLN。术中用手持式γ探测仪有27例患者探测到SLN,共计70个,检出率为90.0%(27/30)。γ探测仪探测SLN数目与SPECT-CT淋巴显像数目有4例不一致,24例符合,其符合率为85.7%(24/28)。病理结果显示,6例患者有淋巴结转移,占20.0%。SLN检测的灵敏度、特异度、准确率和假阴性率分别为83.3%、95.8%、93.3%和16.7%。结论 术前SPECT-CT淋巴显像能有效探测喉癌患者的SLN,准确预测颈部淋巴结转移情况。 相似文献
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口腔癌前哨淋巴结显像与术中γ探测 总被引:1,自引:0,他引:1
目的探讨淋巴显像及术中γ探测定位活组织检查口腔癌前哨淋巴结(SLN)的临床价值.方法术前在口腔肿瘤表面正中黏膜内(舌癌于肿瘤远心端边缘)注射37~74 MBq ^99Tc^m-右旋糖酐(DX),行淋巴显像及术中γ探测定位口腔癌SLN,术中切除SLN,并行常规颈淋巴结清扫术.将切除的口腔肿瘤及淋巴结行病理检查,分析SLN和远端淋巴结转移的关系.结果33例患者口腔癌SLN及淋巴引流显像清晰,共检出SLN 43枚,其中1枚者25例,2枚者6例,3枚者2例.SLN病理检查结果有转移者9例,颈清扫淋巴结转移者共11例,2例SLN阴性而远处淋巴结转移,1例仅有SLN转移.口腔癌SLN γ探测定位检出率100%.SLN活组织病理检查灵敏度为81.82%(9/11例),准确性为93.94%,假阴性率为18.18%(2/11例),假阳性率为0.结论淋巴显像是定位口腔癌SLN的基础,术中γ探测是定位口腔癌SLN的可靠手段. 相似文献
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目的 评价前哨淋巴结(SLN)显像等指导活组织检查技术(SLNB)在口腔鳞癌分期诊断中的作用.方法 Cn0期口腔癌患者31例,肿瘤旁黏膜下注射专利蓝和99Tcm-右旋糖酐(DX),分别采用蓝染法、淋巴显像法、术中γ探测法定位SLN.行常规病理检查,同时对常规切片阴性者采用连续切片,分别进行HE染色和鼠抗人角蛋白抗体(Ael/AE3)免疫组织化学检测.计算SLN的检出率及评价cNo期口腔鳞癌颈部淋巴结真实状态.结果 用蓝染法、γ探测、淋巴显像分别检测出25(80.6%),31(100.0%),30(96.8%)例的SLN,SLN分别为44,55,51枚,平均每例1.4(1~3)枚.非 SLN(NSLN)1302枚.常规病理检查SLN转移(阳性)6枚(6例),其中1例伴NSLN转移.连续切片+常规HE染色检出I例SLN转移.续切片+AE1/AE3免疫组织化学染色检出2例SLN转移.未发现单独的NSLN转移病例.结论 蓝染法、γ探测和淋巴显像对SLN均具有较高的检出率,其指导的SLNB检测可显示cN0期口腔鳞癌颈部淋巴结的真实状态;连续病理切片和AE1/AE3免疫组织化学检测有助于微小转移灶的检出. 相似文献
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应用γ探测仪探测乳腺癌前哨淋巴结的临床价值 总被引:1,自引:1,他引:0
目的 探讨应用γ探测仪探测乳腺癌前哨淋巴结活组织检查(SLNB)的临床价值。方法 53例乳腺癌患者,在肿块或活组织检查腔周围的乳腺实质内注射^99Tc^m-硫胶体,应用γ探测仪术中定位切除放射性浓聚的前哨淋巴结(SLN),再行腋窝淋巴结清扫(ALND)。SLN与腋窝淋巴结(ALN)同时行HE和免疫组织化学(IHC)检测,以及用逆转录多聚酶链反应(RT-PCR)检测CK19 mRNA的表达,观察SLN的检出率和用SLN预测ALN转移的准确性,评价SLN阴性的早期乳腺癌患者用SLNB代替ALND的可行性。结果 SLN检出灵敏度为91%(48/53例),共检出SLN91枚,平均1.9枚。SLN预测ALN转移准确性为100%,阳性预测值为0。结论 术中用γ探测仪进行乳腺癌SLNB是可行的,SLN可预测腋窝其余淋巴结的转移情况,并可作为早期乳癌患者用SLNB代替ALND的可靠指标。 相似文献
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Amparo Garcia-Burillo Isabel Roca Bielsa Oscar Gonzalez Carles Zafon Monica Sabate Josep Castellvi Xavier Serres Carmela Iglesias Ramon Vilallonga Enric Caubet Jose Manuel Fort Jordi Mesa Manuel Armengol Joan Castell-Conesa 《European journal of nuclear medicine and molecular imaging》2013,40(11):1645-1655
Purpose
Lymphadenectomy in papillary thyroid carcinoma (PTC) continues to be controversial. A better staging method is needed to provide adequate individual surgical treatment. SPECT/CT lymphoscintigraphy and sentinel lymph node (SLN) biopsy may improve lymphatic staging and surgical treatment. Our main objectives were to describe the lymphatic drainage of PTC using lymphoscintigraphy, to evaluate the lymphatic spread (comparing SLN and lymphadenectomy results) and to analyse the impact of SLN identification in surgery.Methods
We prospectively studied 24 consecutive patients with PTC (19 women; mean age 52.7 years, range 22–81 years). The day before surgery, lymphoscintigraphy with ultrasound-guided intratumoral injection (99mTc-nanocolloid, 148 MBq) was performed, obtaining planar and SPECT/CT images. All patients underwent total thyroidectomy, SLN biopsy (hand-held gamma probe) with perioperative analysis, central compartment node dissection, or laterocervical lymphadenectomy if perioperative stage N1b or positive SLNs in this lymphatic basin.Results
Lymphoscintigraphy revealed at least one SLN in 19 of 24 patients (79 %) on planar and SPECT/CT images, and in 23 of 24 patients (96 %) during surgery using a hand-held gamma probe. Lymph node metastases were detected with classical perioperative techniques (ultrasound guidance and surgical inspection) in 3 of 24 patients, by perioperative SLN analysis in 10 of 23, and by definitive histology in 13 of 24. The false-negative (FN) ratio for SLN was 7.7 % (one patient with bulky lymph nodes). The FN ratio for perioperative frozen sections was 15.4 % (two patients, one with micrometastases, the other with bilateral SLN). Lymphatic drainage was only to the central compartment in 6 of 24 patients (3 of the 6 with positive SLNs for metastases), only to the laterocervical basin in 5 of 24 patients (all unilateral, 2 of 5 positive SLNs) and to the central and laterocervical compartments in 12 of 24 patients (6 of 12 and 3 of 12 positive SLNs, respectively).Conclusion
Lymphoscintigraphy reveals the lymph node drainage in a high proportion of patients. It detects laterocervical drainage in a significant percentage of patients, allowing the detection of occult lymph node metastases and improving the surgical management in PTC. 相似文献12.
Pelizzo MR Rubello D Boschin IM Piotto A Paggetta C Toniato A De Salvo GL Giuliano A Mariani G Casara D 《European journal of nuclear medicine and molecular imaging》2007,34(6):934-938
Purpose It is a matter of controversy whether prophylactic lymph node dissection improves prognosis and survival in papillary thyroid
carcinoma (PTC) patients without suspicion of lymph node metastases either clinically or on ultrasonography. It is possible
that in such patients the use of lymphatic mapping and sentinel lymph node (SLN) biopsy, as are employed for other tumours,
will be of assistance. The aim of this study was to evaluate the feasibility of preoperative 99mTc-nanocolloid lymphoscintigraphy and an intra-operative SLN procedure in the management of PTC patients.
Methods Twenty-five consecutive patients were entered in the study between April 2005 and October 2005. All had a preoperative diagnosis
of malignancy obtained by fine-needle aspiration cytology (FNAC), without clinical or ultrasonographic evidence of loco-regional
lymph node involvement. Patients underwent preoperative lymphoscintigraphy after the injection of 99mTc-nanocolloid [median 6 MBq (range 4–9 MBq) in 0.1–0.2 ml saline injected intratumorally under ultrasound guidance] and an
intra-operative SLN procedure using a hand-held gamma probe. Surgery was performed by the same surgeon in all patients.
Results Preoperative lymphoscintigraphy identified at least one SLN in all patients. During surgery, using the gamma probe, the surgeon
was able to find at least one SLN in all cases. A good correlation was found between preoperative imaging and probe results.
Metastasis was found in at least one SLN in 12 (48%) patients. In seven (28%) patients the involved SLN was the most radioactive
SLN, while in five (20%) patients a less radioactive SLN was involved by malignancy. Ten of these 12 patients had only micrometastases
(<2 mm). Micrometastases were found in the most radioactive SLN in six cases and in less radioactive SLNs in four cases, while
in two patients more lymph nodes visualised at lymphoscintigraphy ipsilateral to the primary tumour were sites of metastasis.
Conclusion The rate of nodal involvement was very high in our series: in 48% of patients at least one metastatic lymph node was found.
From a technical point of view the intra-operative SLN procedure in PTC patients was easy to perform, without major intra-operative
complications. Our promising preliminary experience needs to be confirmed in larger series of patients series with longer
follow-up. 相似文献
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Kara PP Ayhan A Caner B Gültekin M Ugur O Bozkurt MF Usubutun A 《Annals of nuclear medicine》2008,22(6):487-494
OBJECTIVE: The objective of this prospective study was to determine the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer using lymphoscintigraphy (LS), gamma probe, and blue dye. METHODS: A total of 32 patients with early stage cervical cancer (FIGO IA2-IIA) who were treated with total abdominal hysterectomy and bilateral pelvic and paraortic lymphadenectomy underwent SLN biopsy. LS was performed on all the patients following the injection of 74 MBq technetium-99m-nanocolloid pericervically. The first appearing persistent focal accumulation on either dynamic or static images of LS was considered to be an SLN. Blue dye was injected just prior to surgical incision in 16 patients (50%) at the same locations as the radioactive isotope injection. During the operation, blue-stained node(s) were excised as SLNs. For gamma probe, a lymph node was accepted as an SLN, if its ex vivo radioactive counts were at least 10-fold above background radioactivity. SLNs, which were negative by routine hematoxylin and eosin (H&E) examination, were histopathologically reevaluated for the presence of micrometastases by step sectioning and immunohistochemical staining with pancytokeratin. RESULTS: At least one SLN was identified for each patient by gamma probe. Intraoperative gamma probe was the most sensitive method with a technical success rate of SLN detection of 100% (32/32), followed by LS 87.5% (28/32) and blue dye 68.8% (11/16), respectively. The average number of SLNs per patient detected by gamma probe was 2.09 (range 1-5). The localizations of the SLNs were external iliac 47.8%, obturatory 32.8%, common iliac 9%, paraaortic 4.4%, and paracervical 6%. Micrometastases, not detected by routine H&E were found by immunohistochemistry in one patient. On the basis of the histopathological analysis, the negative predictive value for predicting metastases was 100%, and there were no false-negative results. CONCLUSIONS: Preoperative LS with radiocolloids, intraoperative lymphatic mapping with blue dye and gamma probe are all feasible methods comparable with each other for SLN detection in early stage cervical cancer patients, but gamma probe is the most useful method in terms of technical success. 相似文献
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Maza S Taupitz M Taymoorian K Winzer KJ Rückert J Paschen C Räber G Schneider S Trefzer U Munz DL 《European journal of nuclear medicine and molecular imaging》2007,34(3):378-383
Purpose There are situations where exact identification and localisation of sentinel lymph nodes (SLNs) are very difficult using lymphoscintigraphy,
a hand-held gamma probe and vital dye, either a priori or a posteriori. We developed a new method using a simultaneous injection
of two lymphotropic agents for exact topographical tomographic localisation and biopsy of draining SLNs. The purpose of this
prospective pilot study was to investigate the feasibility and efficacy of this method ensemble.
Methods Fourteen patients with different tumour entities were enrolled. A mixture of 99mTc-nanocolloid and a dissolved superparamagnetic iron oxide was injected interstitially. Dynamic, sequential static lymphoscintigraphy
and SPECT served as pathfinders. MR imaging was performed 2 h after injection. SPECT, contrast MRI and, if necessary, CT scan
data sets were fused and evaluated with special regard to the topographical location of SLNs. The day after injection, nine
patients underwent SLN biopsy and, in the presence of SLN metastasis, an elective lymph node dissection.
Results Twenty-five SLNs were localised in the 14 patients examined. A 100% fusion correlation was achieved in all patients. The anatomical
sites of SLNs detected during surgery showed 100% agreement with those localised on the multimodal fusion images. SLNs could
be excised in 11/14 patients, six of whom had nodal metastasis.
Conclusion Our novel approach of multimodal fusion imaging for targeted SLN management in primary tumours with lymphatic drainage to
anatomically difficult regions enables SLN biopsy even in patients with lymphatic drainage to obscure regions. Currently,
we are testing its validity in larger patient groups and other tumour entities. 相似文献
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L Rettenbacher J Koller H K?ssmann J Holzmannhofer T Rettenbacher G Galvan 《Journal of nuclear medicine》2001,42(3):424-429
The aim of the study was to determine whether the sentinel lymph node (SLN) can be accurately detected in cutaneous melanoma patients when the injection distance from the tumor site is expanded. METHODS: In 100 patients with cutaneous melanoma, lymphoscintigraphy was performed twice. First, we injected 37 MBq (99m)Tc nanocolloid intracutaneously at a 2- to 5-mm distance from either the melanoma or the biopsy scar. The injection was followed by dynamic imaging, which continued until the SLN became visible. On another day, we repeated the investigation, injecting the radiopharmaceutical intracutaneously exactly 10 mm from the previous injection site. The detected SLNs of both investigations were compared to determine the number and location of SLNs for each patient. RESULTS: The SLN identification rate was 94% with close injection and 100% with 10-mm-distant injection. All SLNs detected with close injection were visible with distant injection. In 84 of 100 patients, the images of both investigations showed the same number and location of SLNs. In the remaining 16 patients, an additional SLN was detected with the distant injection. CONCLUSION: The reproducibility of lymphoscintigraphy using different injection distances was 84%. The discordance in the remaining 16% was caused by detection of a lymph node in addition to the original SLN with distant injection. Diagnostic excision of the primary tumor before lymphoscintigraphy was possible without preventing detection of the original SLN. However, in 16% of our patients, excision of an additional lymph node had to be considered when lymphoscintigraphy was performed after diagnostic excision. 相似文献
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Chang Ju Na Jeonghun Kim Sehun Choi Yeon-Hee Han Hwan-Jeong Jeong Myung-Hee Sohn Hyun Jo Youn Seok Tae Lim 《Nuclear Medicine and Molecular Imaging》2015,49(1):26-32
Purpose
Hybrid imaging techniques can provide functional and anatomical information about sentinel lymph nodes in breast cancer. Our aim in this study was to evaluate which imaging parameters on hybrid sentinel lymphoscintigraphy predicted metastatic involvement of sentinel lymph nodes (SLNs) in patients with breast cancer.Methods
Among 56 patients who underwent conventional sentinel lymphoscintigraphy, 45 patients (age, 53.1 ± 9.5 years) underwent hybrid sentinel lymphoscintigraphy using a single-photon emission computed tomography (SPECT)/computed tomography (CT) gamma camera. On hybrid SPECT/CT images, we compared the shape and size (long-to-short axis [L/S] ratio) of the SLN, and SLN/periareolar injection site (S/P) count ratio between metastatic and non-metastatic SLNs. Metastatic involvement of sentinel lymph nodes was confirmed by pathological biopsy.Results
Pathological biopsy revealed that 21 patients (46.7 %) had metastatic SLNs, while 24 (53.3 %) had non-metastatic SLNs. In the 21 patients with metastatic SLNs, the SLN was mostly round (57.1 %) or had an eccentric cortical rim (38.1 %). Of 24 patients with non-metastatic SLNs, 13 patients (54.1 %) had an SLN with a C-shape rim or eccentric cortex. L/S ratio was 2.04 for metastatic SLNs and 2.38 for non-metastatic SLNs. Seven (33 %) patients had T1 primary tumors and 14 (66 %) had T2 primary tumors in the metastatic SLN group. In contrast, 18 (75 %) patients had T1 primary tumors and six (25 %) had T2 tumors in the non-metastatic SLN group. S/P count ratio was significantly lower in the metastatic SLN group than the non-metastatic SLN group for those patients with a T1 primary tumor (p = 0.007).Conclusions
Hybrid SPECT/CT offers the physiologic data of SPECT together with the anatomic data of CT in a single image. This hybrid imaging improved the anatomic localization of SLNs in breast cancer patients and predicted the metastatic involvement of SLNs in the subgroup of breast cancer patients with T1 primary tumors. 相似文献17.
Federica Elisei Cinzia Crivellaro Daniela Giuliani Carlotta Dolci Elena De Ponti Luca Montanelli Maria La Manna Luca Guerra Maurizio Arosio Claudio Landoni Alessandro Buda 《Annals of nuclear medicine》2017,31(1):93-99