^(99m)锝标记的二巯基丁二酸检测口腔癌颈淋巴结转移的研究

Application of ^(99m)Tc(V)-dimercaptosuccinic acid imaging in detecting neck metastases in patients with oral squamous cell carcinoma

目的 探讨5价99m锝标记的二巯基丁二酸(99mTc(V)-dimercaptosuccinic acid,99mTc(V)-DMSA)寻找口腔癌颈部淋巴结转移灶的可行性,为制定合理的口腔癌颈淋巴清扫术式提供参考。方法 原发口腔鳞状细胞癌32例,行99mTc(V)-DMSA头颈部单光子发射型计算机断层(singlephoton emission comprter tomography,SPECT)显像,寻找异常放射浓聚区域,将结果和术后病理比较。假阳性患者的淋巴结行半连续病理切片观察。结果 99mTc(V)-DMSA SPECT寻找颈部淋巴结转移灶的灵敏度为75.0％(9/12),特异性为90.0％(18/20),准确度为84.4％(27/32)。9例颈部有异常放射性浓聚的患者感兴趣区放射性摄取值:患侧147.4-627.8,平均387.6;健侧12.56-458.4,平均235.48,配对t检验,t=8.128,P=0.00004。假阳性患者淋巴结半连续病理切片未发现癌转移。结论 99mTc(V)-DMSA对头颈部恶性肿瘤和转移的淋巴结有较高的亲和性,其检测颈淋巴结转移准确度高,可检出颈部隐性转移的淋巴结,为制定颈淋巴清扫术提供参考。

Objective To evaluate the applicability of 99mTc(V)-dimercaptosuccinic acid (99mTc (V)-DMSA) imaging in detecting neck metastases in patients with oral squamous cell carcinoma. Methods Single photon emission computer tomography (SPECT) scintigraphy with 99mTc(V)-DMSA was performed on 32 patients with primary squamous cell carcinoma in oral cavity. The coronal aspect of SPECT image was chosen, the region of interest (ROI) of the affected neck was drawn, and the radioactivity uptake value of the ROI was given by the computer to compare with the contralateral neck. The results of 99mTc(V)-DMSA were compared with postoperative pathological studies. For false positive lymph nodes, semi-continuous slice was carried out for pathology examination. Results The sensitivity, specificity and accuracy of 99mTc(V)-DMSA imaging for detecting metastatic lymph nodes were 75. 0% , 90. 0% and 84. 4% respectively. The ROI values of the affected neck are higher than that of the contralateral part in the 9 positive patients (t = 8. 128 ,P =0. 000 04). Metastasis was not found in the enlarged lymph nodes of the false positive patients. Conclusions 99mTc(V)-DMSA SPECT imaging has fairly high affinity with metastatic lymph nodes in the neck especially in the cNO patients and is helpful for designing proper neck dissection.