口腔鳞癌前哨淋巴结融合显像检测的研究

SPECT CT lymphoscintigraphy in sentinel lymph node detection of oral squamous cell carcinoma

目的:通过SPECTCT对早期口腔鳞癌进行术前淋巴显像,评价其在前哨淋巴结(SLN)检测及定位中的意义。方法:应用带低能X线的多功能ECT对21例口腔鳞癌患者进行术前同机融合断层淋巴显像,配合术中注射蓝染法对SLN进行检测并与平面显像比较,评价其优越性。结果:断层显像更加准确地定位并纠正了部分平面显像的定位:包括发现了7例平面显像中未显示的或不同淋巴引流床中的SLN、1例平面显像拟诊为SLN的部位经断层显像及蓝染法确认为注射点的散射引起误诊、1例为因SLN接近注射点在平面显像图上未显示SLN而出现漏诊。断层显像还发现了平面显像未发现的另5个病人具有双侧淋巴引流途径。平面显像、融合显像的SLN检出率分别为95.2%和100%。对全部切除淋巴结进行病理检查发现,21例病人中共检出29个SLN,其中4个SLN病理检查为阳性,SLN隐性转移率为13.8%(429),未见假阴性。结论:SPECTCT淋巴显像对局部SLN提供了较详细的解剖定位标志,有利于准确定位SLN。淋巴断层显像能检出平面显像不易发现的SLN,对局部SLN的分布提供了较多的信息,提高了SLN的检出率,减少漏检率,值得临床推广应用。

Objective： Preoperative lymphoscintigraphy（LS） is important in localization of the sentinel lymph node（SLN）. The present study evaluated the benefit of SPECT/CT in LS for the preoperative localization of the SLN. Methods： Twentyone clinically negative patients with T1 or T2 oral squamous cell carcinoma were enrolled. LS underwent by SPECT/CT. Planar and fusion images were interpreted separately. Results： In all patients, SPECT/CT fusion images confirmed the localization obtained by planar images and skin marking. Moreover, in 9 of 21 patients, the fusion images improved or corrected the preoperative localization of the SLN on planar images： 7 nodes that had been identified only on fused images were located in basins other than or in addition to the basins identified on planar images, 1 node that was located closed to the injection site was hidden by its scattered radiation on planar imaging, and 1 node erroneously diagnosed that was also affected by injection radiation scatter. In addition, fusion images identified bilateral draining basins in 6 of the 21 patients, however planar images only in 1 of 21. The SLN were successfully revealed in planar and fused images, with a detection rate of 95.2% and 100% respectively. Histologic examination confirmed the metastatic involvement of the SLN in 4 of 21 patients, the SLN positive rate was 13.8%, and there were no false negatives. Conclusion： Our results showed the additional value of SPECT/CT fusion imaging to planar imaging and sharpen the localization of the SLN that are of clinically relevance to SLNB in patients with oral squamous cell carcinoma. And fusion images provide the topographic landmarks that may further facilitate surgical exploration.