口腔鳞癌哨位淋巴结融合显像定位的初步研究

目的：探索一种准确、实用、经济的口腔鳞癌哨位淋巴结定位方法。方法：选择拟行一侧选择性颈淋巴清扫术的T1/T3N0M0口腔鳞癌患者25例,术前行平面淋巴显像和SPECT/CT融合显像,联合术中蓝染法定位哨位淋巴结,分别比较平面淋巴显像和融合显像的结果,以及哨位淋巴结和颈清标本的病理结果。结果：术前平面淋巴显像的25例患者中,23例显示哨位淋巴结;应用SPECT/CT同机融合显像技术,25例患者均能显示哨位淋巴结（25/25）。融合显像发现,平面显像未能显示的哨位淋巴结7枚,其中1枚存在肿瘤转移。所有出现核素浓聚的淋巴结,均能在融合图像中获得较为准确的解剖定位。哨位淋巴结对颈淋巴结状况预测的敏感度为85.7%,特异度及阳性预测值为100%,阴性预测值为94.7%,准确度为96%。结论：SPECT/CT同机融合显像技术能提供比平面淋巴显像更多的信息,降低了哨位淋巴结活检的假阴性率;是一种较为准确、实用、经济的定位口腔鳞癌哨位淋巴结的新方法。

Sentinel lymph node localization for oral squamous cell carcinoma using a hybrid SPECT/CT system

PURPOSE： To explore an accurate, available, economic method in sentinel lymph node （SLN） localization in cN0 oral squamous cell carcinoma. METHODS： Sentinel lymph nodes of twenty-five patients with oral squamous cell carcinoma without clinical lymph metastasis were investigated using planer and SPECT/CT fused lymphoscintigraphy combined with methylene blue. The results of fused images were compared with planer images for SLN mapping in cN0 oral squamous cell carcinoma, SLNs were identified according to color and fused images. Neck dissection were performed. The pathological results of SLNs were compared with that of the remaining neck dissection. RESULTS： SLNs were identified in 23 of the 25 patients using planer lymphoscintigraphy. SLNs were successfully identified in all 25 patients using SPECT/CT fused lymphoscintigraphy.Fusing images provided better anatomic definition in all SLNs. SPECT/CT fused images identified 7 SLNs that were missed on planar lymphoscintigraphy, one of the 7 nodes contained tumor metastasis. There was one false-negative case. The sensitivity was 85.7%, accuracy was 96%, and specificity of SLNs was 100%. CONCLUSIONS： SLNs mapping using a hybrid SPECT/CT system can provide additional data which can not be offered by planar lymphoscintigraphy and can reduce false-negative finding, It is regarded as an accurate, available, economical new approach in SLN radiolocalization in oral squamous cell carcinoma.