两种SPECT/CT前哨淋巴结显像剂用于单侧乳腺癌患者诊断价值比较
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摘要
目的探讨99m锝甘露糖苷(~(99) Tc~m-TMC)与99m锝硫胶(~(99)Tc~m-SC) SPECT/CT前哨淋巴结(SLN)显像方案用于单侧乳腺癌患者诊断价值差异。方法研究对象选取我院2017年1月至2018年3月收治单侧乳腺癌患者共147例,根据前哨淋巴结显像方案分为A组(77例)和B组(70例),分别在SPECT/CT下行~(99)Tc~m-TMC与~(99)Tc~m-SC显像,比较两组SLN显像数目,SLN显像阳性率,SLN显像≤3枚百分比,术中SLN检出数目及术中SLN检出≤3枚百分比,并统计组内显像和术中SLN检出情况。结果 B组患者SLN显像数目显著多于A组(P <0. 05);两组患者SLN显像阳性率比较差异无显著性(P>0.05);B组患者SLN显像≤3枚百分比显著少于A组(P <0.05);两组SPECT/CT下SLN显像数目均显著多于多平面SLN显像数目(P <0. 05); B组患者术中SLN检出数目显著多于A组(P <0. 05); B组患者术中SLN检出≤3枚百分比显著少于A组(P <0. 05);同时两组患者术中SLN检出数目均显著多于SPECT/CT下显像(P <0. 05)。结论 99Tc~m-TMC前哨淋巴结显像方案用于单侧乳腺癌患者SLN定位准确性更佳,能够最大限度改善术后患侧上肢功能和生存质量,价值优于~(99)Tc~m-SC。
Objective To investigate the difference between the clinical diagnostic value of two SPECT/CT sentinel lymph node imaging agent,~(99)Tc~m-TMC and ~(99)Tc~m-SC,on patients with unilateral breast cancer.Methods 147 patients with unilateral breast cancer were chosen from January 2017 to March 2018, and randomly divided into 2 groups including A group(77 patients) with SPECT/CT sentinel lymph node imaging agent ~(99)Tc~m-TMC and B group(70 patients) with ~(99)Tcm-SC. The number of SLN imaging, the positive rate of SLN imaging, the percentage of SLN imaging number ≤3, the detected number of SLN in operation and the percentage of detected SLN number ≤3 of both groups were then compared and the SLN detection rate for imaging and in operation situation in 2 groups were counted. Results The SLN imaging number of B group were significantly more than A group(P < 0. 05). There was no significant difference in the positive rate of SLN imaging between 2 groups(P >0.05). The percentage of SLN imaging number ≤3 of B group were significant less than A group(P <0.05). The SLN imaging number by SPECT/CT of both groups were significantly more than multiplane(P < 0. 05). The detected number of SLN in operation of B group were significantly more than A group(P <0. 05). The percentage of detected SLN number ≤ 3 in operation of B group were significantly less than A group(P <0. 05). The detected SLN number ≤3 in operation of both groups were significantly more than multiplane(P < 0. 05). Conclusion Compared with~(99)Tc~m-SC,the agent ~(99)Tc~m-TMC on patients with unilateral breast cancer possess the better accuracy of localization and can efficiently improve the upper extremity function and quality of life.
Objective To investigate the difference between the clinical diagnostic value of two SPECT/CT sentinel lymph node imaging agent,~(99)Tc~m-TMC and ~(99)Tc~m-SC,on patients with unilateral breast cancer.Methods 147 patients with unilateral breast cancer were chosen from January 2017 to March 2018, and randomly divided into 2 groups including A group(77 patients) with SPECT/CT sentinel lymph node imaging agent ~(99)Tc~m-TMC and B group(70 patients) with ~(99)Tcm-SC. The number of SLN imaging, the positive rate of SLN imaging, the percentage of SLN imaging number ≤3, the detected number of SLN in operation and the percentage of detected SLN number ≤3 of both groups were then compared and the SLN detection rate for imaging and in operation situation in 2 groups were counted. Results The SLN imaging number of B group were significantly more than A group(P < 0. 05). There was no significant difference in the positive rate of SLN imaging between 2 groups(P >0.05). The percentage of SLN imaging number ≤3 of B group were significant less than A group(P <0.05). The SLN imaging number by SPECT/CT of both groups were significantly more than multiplane(P < 0. 05). The detected number of SLN in operation of B group were significantly more than A group(P <0. 05). The percentage of detected SLN number ≤ 3 in operation of B group were significantly less than A group(P <0. 05). The detected SLN number ≤3 in operation of both groups were significantly more than multiplane(P < 0. 05). Conclusion Compared with~(99)Tc~m-SC,the agent ~(99)Tc~m-TMC on patients with unilateral breast cancer possess the better accuracy of localization and can efficiently improve the upper extremity function and quality of life.
引文
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[12] BAKER J L,PU M, TOKIN C A, et al. Comparison of[99mTc]tilmanocept and[99mTc] sulfur colloid for identification of sentinel lymph nodes in clinically node-negative breast cancer patients[J].Tropical Plant Pathology,2013,36(3):133-140.
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[15] WADASAKIK, NISHIBUCHI I. Relationship between sentinel lymph nodes and postoperative tangential fields in early breast cancer,evaluated using SPECT/CT[J]. Int J Radiation Oncol Biol Physics,2015,93(3):E22-E22.
[16] ZHANG Y,SHI H, LI B, et al. Diagnostic value of 99Tcm-MDP SPECT/spiral CT combined with three-phase bone scintigraphy in assessing suspected bone tumor of patients without malignant history[J]. Nuclear Med Commun,2015,36(7):686-692.
[2] GROHEUX D,FERRE R,RUBELLO D,et al. Breast cancer patient with an uncommon lymphatic drainage evidenced by SPECT/CT[J]. Clin Nuclear Med,2014,39(2):176-179.
[3] NAVALKISSOOR S, WAGNER T, GNANASEGARAN G, et al.SPECT/CT in imaging sentinel nodes[J]. Clin Translat Imaging,2015,3(3):1-13.
[4] SERRANO-VICENTE J, RAYO-MADRID J I, DOMINGUEZGRANDE M L,et al. Role of SPECT-CT in breast cancer sentinel node biopsy when internal mammary chain drainage is observed[J]. Clin Translat Oncol,2016,18(4):418-425.
[5] BLUEMEL C, SAFAK G, CRAMER A, et al. Fusion of freehand SPECT and ultrasound:First experience in preoperative localization of sentinel lymph nodes[J]. Euro J Nuclear Med Molec Imaging,2016,43(13):1-9.
[6] KLAPDOR R,LANGER F,GRATZ K F,et al. SPECT/CT for SLN dissection in vulvar cancer:Improved SLN detection and dissection by preoperative three-dimensional anatomical localization[J].Gynecol Oncol,2015,138(3):590-596.
[7] PIATO J R,FILASSI J R, DELA VEGA A J, et al. SPECT-CTGuided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients With Breast Cancer:A Pilot Study[J]. Innovations,2016,11(4):112-115.
[8] LUO R,NIU L,QIU F,et al. Monitoring Apoptosis of Breast Cancer Xenograft After Paclitaxel Treatment with 99mTc-Labeled Duramycin SPECT/CT[J]. Molec Imaging, 2016, 15(8):110-117.
[9] CHEN Q,MA Q,CHEN M,et al. An Exploratory Study on 99mTcRGD-BBN Peptide Scintimammography in the Assessment of Breast Malignant Lesions Compared to 99mTc-3P4-RGD2[J]. PloS One,2015,10(4):e0123401.
[10] UNKART JT,AVAHOSSEINI M D, WALLACE A M. Tc-99m tilmanocept versus Tc-99m sulfur colloid in breast cancer sentinel lymph node identification:Results from a randomized, blinded clinical trial[J]. J Surg Oncol,2017,116(7):13-18.
[11] ZOGAKIS T G,WETHERILLE R E, CHRISTENSEN R D, et al.Intraoperative Subareolar Injection of 99 m Tc-Labeled Sulfur Colloid Results in Consistent Sentinel Lymph Node Identification[J].Annals Surg Oncol,2005,12(2):167-172.
[12] BAKER J L,PU M, TOKIN C A, et al. Comparison of[99mTc]tilmanocept and[99mTc] sulfur colloid for identification of sentinel lymph nodes in clinically node-negative breast cancer patients[J].Tropical Plant Pathology,2013,36(3):133-140.
[13] BAKER J L,PU M,TOKIN C A,et al. Comparison of[(99m)Tc]tilmanocept and filtered[(99m)Tc] sulfur colloid for identification of SLNs in breast cancer patients[J]. Annals Surg Oncol.2015,22(1):40-45.
[14] XIA G,AN C,MING Z, et al. 18F-FDG-PET/CT versus 99TcmMIBI-SPECT:which is better for detection of solitary pulmonary nodules?[J]. J Buon,2017,22(5):1246-1251.
[15] WADASAKIK, NISHIBUCHI I. Relationship between sentinel lymph nodes and postoperative tangential fields in early breast cancer,evaluated using SPECT/CT[J]. Int J Radiation Oncol Biol Physics,2015,93(3):E22-E22.
[16] ZHANG Y,SHI H, LI B, et al. Diagnostic value of 99Tcm-MDP SPECT/spiral CT combined with three-phase bone scintigraphy in assessing suspected bone tumor of patients without malignant history[J]. Nuclear Med Commun,2015,36(7):686-692.