SPECT/CT同机融合显像在口腔鳞癌前哨淋巴结定位中的应用
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摘要
目的探索一种准确、实用的口腔鳞癌前哨淋巴结定位方法。方法术前运用SPECT/CT同机融合显像技术对30例c N0期口腔鳞癌患者的SLN进行定位,术中对定位的SLN活检,术后比较SLN与颈淋巴清扫的病理结果。结果全组病例中,SPECT/CT同机融合图像对SLN定位的准确度为100%,8例患者的前哨淋巴结和颈清扫淋巴结病理结果证实有癌转移,前哨淋巴结活检对颈部淋巴结转移状况评价的敏感度、特异度和准确度均为100%。结论 SPECT/CT同机融合显像技术可以在术前准确定位前哨淋巴结,客观评价c N0期口腔鳞癌患者颈部淋巴结的真实状况。
Objective To explore an accurate and available method in sentinel lymph node localization in c N0 oral squamous cell carcinoma. Methods Preoperative sentinel lymph node localization by SPECT / CT Co-registration Fusion Scintigraphy and intraoperative sentinel lymph node biopsy was performed to evaluate the cervical lymph node status in 30 cases of c N0 oral squamous cell carcinoma and the pathological results of SLN and neck dissection were compared after the operation. Results Among all the 30 cases,the accuracy rating of sentinel lymph node localization by SPECT / CT Co-registration Fusion Scintigraphy was 100%. Sentinel lymph nodes were found with metastasis in 8 cases. No non-sentinel lymph node was found with metastasis while sentinel lymph nodes were pathologically negative. The sensitivity,specificity and accuracy of evaluation of neck lymph node metastasis were 100%. Conclusions Preoperative SPECT / CT Co-registration Fusion Scintigraphy can be used to locate sentinel lymph node and accurately evaluate the statue of cervical lymph node metastasis in c N0 oral squamous cell carcinoma.
Objective To explore an accurate and available method in sentinel lymph node localization in c N0 oral squamous cell carcinoma. Methods Preoperative sentinel lymph node localization by SPECT / CT Co-registration Fusion Scintigraphy and intraoperative sentinel lymph node biopsy was performed to evaluate the cervical lymph node status in 30 cases of c N0 oral squamous cell carcinoma and the pathological results of SLN and neck dissection were compared after the operation. Results Among all the 30 cases,the accuracy rating of sentinel lymph node localization by SPECT / CT Co-registration Fusion Scintigraphy was 100%. Sentinel lymph nodes were found with metastasis in 8 cases. No non-sentinel lymph node was found with metastasis while sentinel lymph nodes were pathologically negative. The sensitivity,specificity and accuracy of evaluation of neck lymph node metastasis were 100%. Conclusions Preoperative SPECT / CT Co-registration Fusion Scintigraphy can be used to locate sentinel lymph node and accurately evaluate the statue of cervical lymph node metastasis in c N0 oral squamous cell carcinoma.
引文
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[14]Pitman KT,Johnson JT,Edington H,et al.Lymphatic mapping with isosulfan blue dye in squamous cell carcinoma of the head and neck[J].Arch Otolaryngol Head Neck Surgery,1998,124(7):790-793.
[15]Koch WM,Choti MA,Civeleck AC,et al.Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma[J].Arch Otolaryngol Head Neck Surg,1998,124(4):455-459.
[16]彭汉伟,曾宗渊,陈福进,等.c N0舌癌前哨淋巴结定位方法研究[J].癌症,2003,22(3):286-290.
[17]张胜,刘生,藕小平,等.口腔鳞癌哨位淋巴结融合显像定位的初步研究[J].中国口腔颌面外科杂志,2009,7(1):23-27.
[2]李金忠,郑家伟.NCNN头颈癌诊治指南2007版(2)[J].中国口腔颌面外科杂志,2008,6(2):154-160.
[3]Pitman KT,Johnson JT,Myers EN.Effectiveness of selective neck dissection for management of the clinically negative neck[J].Arch Otolaryngol,1997,123(9):917-922.
[4]Russolo M,Glacomarra V,Papanikolla L,et al.Prognostic indicastors of lccult metastases in oral cancer[J].Laryngo scope,2002,112(7 pt 1):1320-1323.
[5]Alex JC,Sasaki CT,Krag DN,et al.Sentinel lymph node radiolocalization in head and neck squamous carcinoma[J].Larygoscope,2000,110(2):198-203
[6]王晓雷,屠规益,唐平章.舌鳞癌无临床颈部淋巴结转移的处理[J].中华口腔医学杂志,2000,35(1):12-14.
[7]Shoaib T,Soutar D,Macdonald D,et al.The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0neck[J].Cancer,2001,91(11):2077-2083.
[8]Hirche C,Murawa D,Mohr Z,et al.ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer[J].Breast Cancer Res Treat,2010,121(2):373-378.
[9]张光远,李文涛.乳腺癌前哨淋巴结定位方法研究进展[J].中华放射学杂志,2011,45(7):700-702.
[10]O`Connor R,Pezier T,Svhilling C,et al.The relative cost of sentinel lymph node biopsy in early cancer[J].J Craniomaxillofac Surg,2013,41(8):721-727.
[11]Civantos FJ,Zitsch RP,Schuller DE,et al.Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas:results of a prospective multi-institutional trial[J].J Clin Oncol,2010,28(8):1395-1400.
[12]Govers TM,Hannink G,Merkx MA,et al.Sentinel node biopsy for squamous cell carvinoma of the oral cavity and oropharynx:a diagnostic meta-analysis[J].Oral Oncol,2013,49(8):726-732.
[13]姚红磊,纳应坤,刘华.前哨淋巴结活检判断口腔癌颈部淋巴结转移的系统评价[J].实用口腔医学杂志,2012,28(2):66-68.
[14]Pitman KT,Johnson JT,Edington H,et al.Lymphatic mapping with isosulfan blue dye in squamous cell carcinoma of the head and neck[J].Arch Otolaryngol Head Neck Surgery,1998,124(7):790-793.
[15]Koch WM,Choti MA,Civeleck AC,et al.Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma[J].Arch Otolaryngol Head Neck Surg,1998,124(4):455-459.
[16]彭汉伟,曾宗渊,陈福进,等.c N0舌癌前哨淋巴结定位方法研究[J].癌症,2003,22(3):286-290.
[17]张胜,刘生,藕小平,等.口腔鳞癌哨位淋巴结融合显像定位的初步研究[J].中国口腔颌面外科杂志,2009,7(1):23-27.