SPECT/CT在cN0期甲状腺乳头状癌前哨淋巴结定位中的应用价值

目的 评价SPECT/CT淋巴显像检测cN0期甲状腺乳头状癌（PTC）患者前哨淋巴结（SLN）的价值。 方法 选取2017年4月至11月在山西医科大学第一医院住院的16例淋巴结阴性（cN0）期PTC患者，其中男性2例、女性14例，年龄（47.0±8.4）岁，于手术前行99Tcm-硫体胶（99Tcm-SC）平面显像和SPECT/CT显像检测SLN。手术中使用γ探测仪探测放射性“热点”。将手术切除的SLN及颈部清扫标本进行病理学检查。 结果 16例患者术前 99Tcm-SC平面显像检出SLN 14例，检出率为87.50% （14/16）。术前99Tcm-SC平面显像、SPECT/CT显像分别检出31枚和35枚SLN。术中γ探测仪探测到SLN 13例，共计37枚，检出率为81.25% （13/16）。γ探测仪探测SLN数目与SPECT/CT淋巴显像数目有4例不一致，12例一致，两种方法的一致率为75% （12/16）。病理结果显示，15例患者有淋巴结转移，占93.75% （15/16）。SPECT/CT检测SLN的灵敏度为86.67% （13/15）、准确率为81.25% （13/16）、假阴性率为13.33% （2/15）。 结论 术前SPECT/CT淋巴显像能有效探测cN0期PTC患者的SLN，准确预测颈部淋巴结的转移情况。

Assessment of SPECT/CT in sentinel lymph node location in cN0 papillary thyroid carcinoma

Objective To evaluate the value of SPECT/CT lymphoscintigraphy for sentinel lymph node (SLN) detection in patients with cN0 papillary thyroid carcinoma(PTC). Methods From April to November 2017, 2 male and 14 female patients with cN0 PTC, with mean age of 47.0±8.4 years, and hospitalized in the first Hospital of Shanxi Medical University, were enrolled in this study. Planar and SPECT/CT SLN imaging were performed before operation. All patients underwent intraoperative lymphatic mapping with a handheld gamma probe. All specimens were sent to a pathology laboratory. Results Among the 16 patients, 14 cases of SLN were found, with a detection rate of 87.50% (14/16). Preoperative planar and SPECT/CT fusion images showed 31 and 35 SLNs, respectively. With the application of intraoperative gamma probe, a total of 37 SLNs were detected in 13/16 patients (81.25%). The number of SLNs detected by gamma detector was inconsistent with the SPECT/CT lymphography in 4 cases and consistent in 12 cases. The coincidence rate of the two methods was 75% (12/16). Fifteen patients (93.75%) had lymph node metastasis. The sensitivity, accuracy, and false negative rate of SLN detection were 86.67%, 81.25%, and 13.33%, respectively. Conclusion Preoperative SPECT/CT lymphoscintigraphy can not only enables precise localization of SLN but also detects the cervical lymph node metastasis in patients with cN0 papillary thyroid carcinoma.