SPECT-CT探测喉癌前哨淋巴结

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。

Sentinel lymph node detection by SPECT-CT in patient with laryngeal carcinoma

Objective To evaluate the value of SPECT-CT lympheseintigraphy for sentinel lymph node (SLN) detection in patients with larynx neoplasms. Methods Thirty patients with cN0 laryngeal carcinoma were eligible for the study. Preoperative SPECT-CT lymphoscintigraphy was performed with laryngutracheoscopy guided injection of radioactivity isotope 99Tcm-sulfur colloid (99Tcm-SC) into the laryngeal carcinoma before surgery. The patients underwent intraoperative lympbatic mapping with a handheld gamma-detecting probe. 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. Results Sixty-six SLNs were detected in 28 cases out of the total 30 cases (93.3%). Preoperative planar image and SPECT-CT fusion image detected 61 and 66 SLNs, respectively. With the application of intraoperative gamma probe, SLN was detected in 27/30 patients (90.0%), correlate rate was 85.7% (24/28). Six patients (20.0%) had lymph node metastasis. The sensitivity, specificity, accuracy and false negative rate of SLN detection were respectively 83.3%, 95.8%, 93.3% and 16.7%. Conclusion Preoperative SPECT-CT lymphescintigraphy can not only enables precise localization of SLN but also detect the cervical lymph node metastasis in patients with laryngeal carcinoma.