SPECT—CT探测喉癌前哨淋巴结

Sentinel lymph node detection by SPECT-CT in patient with laryngeal carcinoma

目的评价SPECT—CT淋巴显像探测喉癌患者前哨淋巴结（SLN）的价值。方法30例临床N0期喉癌患者，术前于喉镜引导下注射^99Tc^m-硫胶体（SC），使用SPECT-CT进行SLN显像；同时，术中用1探测仪探测放射性“热点”。将手术切除的SLN及颈清扫标本行病理检查。结果全组30例检出SLN28例，检出率为93．3％。术前平面显像、SPECT-CT分别检出61个和66个SLN。术中用手持式1探测仪有27例患者探测到SLN，共计70个，检出率为90．0％（27／30）。1探测仪探测SLN数目与SPECT-CT淋巴显像数目有4例不一致，24例符合，其符合率为85．7％（24／28）。病理结果显示，6例患者有淋巴结转移，占20．0％。SLN检测的灵敏度、特异度、准确率和假阴性率分别为83．3％、95．8％、93．3％和16．7％。结论术前SPECT—CT淋巴显像能有效探测喉癌患者的SLN，准确预测颈部淋巴结转移情况。

Objective To evaluate the value of SPECT-CT lymphoscintigraphy for sentinel lymph node （SLN） detection in patients with larynx neoplasms. Methods Thirty patients with cN0 laryngeal carcinoma were eligible for the study. Preoperative SPECT-CT lymphoscintigraphy was performed with laryngotracheoscopy guided injection of radioactivity isotope ^99Tc^m-sulfur colloid （^99Tc^m-SC） into the laryngeal carcinoma before surgery. The patients underwent intraoperative lymphatic mapping with a handheld gamma- detecting probe. The results of routine pathologic examination of cervical specimen were set a golden standard to assess the efficacy of SLN biopsy in evaluating the cervical lymph node status. Results Sixty-six SLNs were detected in 28 cases out of the total 30 cases （93.3%）. Preoperative planar image and SPECT-CT fusion image detected 61 and 66 SLNs, respectively. With the application of intraoperative gamma probe, SLN was detected in 27/30 patients （90.0%）, correlate rate was 85.7% （24/28）. Six patients （20.0%） had lymph node metastasis. The sensitivity, specificity, accuracy and false negative rate of SLN detection were respectively 83.3%, 95.8%, 93.3% and 16.7%. Conclusion Preoperative SPECT-CT lymphoscintigraphy can not only enables precise localization of SLN but also detect the cervical lymph node metastasis in patients with laryngeal carcinoma.