PET-CT和SPECT-CT联合在评估颈部淋巴结转移阴性喉鳞癌患者前哨淋巴结微转移中的临床价值

Clinical value of application of PET-CT combined with SPECT-CT in the detection of sentinel lymph node micrometastasis in laryngeal squamous cell carcinoma patients undergoing cN0 stage

目的评价PET-CT与SPECT-CT联合探测在颈部淋巴结转移阴性(cN0期)喉鳞癌患者颈部前哨淋巴结(SLN)转移中的临床应用价值。方法选取15例cN0期喉鳞癌患者,术前行18F-FDG PET-CT显像疑似淋巴结,同时行99锝m-硫胶体(99Tcm-SC)SPECT-CT显影SLN,二者结合对微转移SLN进行定位及定性,术中利用手持式γ探测仪探测确定SLN,将手术切除的SLN及非SLN行术中快速病理检查判断转移。结果 15例喉鳞癌患者术前经PET-CT显像疑似淋巴结及SPECT-CT显影SLN,2例均未显影。其中有13例PET-CT显像13枚疑似淋巴结,SPECT-CT显影23枚SLN,13枚疑似淋巴结均经CT定位与相应SLN重合。术中γ探测仪探出SLN 22枚,符合率为92.3%。手术切除SLN共计23枚,非SLN共计44枚,6例患者(40%)经病理检查证实淋巴结转移,其中SLN的转移度为21.7%(5/23),高于非SLN转移度2.3%(1/44)(P=0.008)。6例患者转移患者显像淋巴结标准化摄取比值(SUV值)均值为3.51±1.76,高于9例无转移患者显像淋巴结的SUV均值1.58±0.64(P=0.010)。SLN检出率为86.7%。SLN检测的灵敏度为83.3%、准确率为86.7%、假阴性率为16.7%。结论术前联合PET-CT与SPECT-CT并参考SUV值对cN0期喉鳞癌患者微转移SLN定性及定位,有助于手术方案选择的合理性,术中结合γ仪探测SLN可提高颈清范围的准确性。

Objective To evaluate PET-CT combined with SPECT-CT in the detection of sentinel lymph node （SLN） in patients with cN0 laryngeal squamous cell carcinoma（LSCC）.Methods Fifteen patients with cN0 LSCC were eligible for the study. With preoperative18F-FDG PET-CT imaging conducted in parallet, the lymphoscintigraphy was performed with radioactivity isotope99Tcm-sulfur colloid （99Tcm-SC）, and the SLN was qualitative and positioned by the combination of the two ways. The SLN was determined using a handheld gamma detection probe during the operation. The surgical removal of the SLNs and SLNs were examined by rapid pathological examination during operation.Results Suspected lymph node was detected with preoperative PET-CT imaging and SLN was detected with SPECT-CT imaging in fifteen patients with LSCC, two cases were not developed by the both of the two ways. In the thirteen cases, 13 suspected lymph nodes were detected by the PET-CT imaging, and 23 SLNs were detected by the preoperative SPECT-CT imaging, of which 13 suspected lymph nodes were consistent with the SLNs by CT positioning. 22 SLNs were detected in 13 cases by intraoperative gamma probe, the correlative rate was 92.3%. The number of surgical removal of SLNs were 23 and 44 of NSLNs. Six patients, accounting for 40%, had lymph node metastasis, based on which the transfer degree of SLN was 21.7%（5/23） which was higher than the 2.3%（1/44）（P=0.008） NSLN transfer degree. The mean of SUN in 6 cases with lymph node metastasis was 3.51±1.76, which was higher than the 9 cases that were without lymph node metastasis whose mean of SUN was 1.58±0.64（P=0.010）. The sensitivity of SLN detection was 83.3%, the accuracy 86.7% and the false negative rate was 16.7%.Conclusions For the preoperative PET-CT combined with SPECT-CT in the qualitative and positioned of the micrometastases SLN among patients with cN0 stage LSCC can be improved, which will help to choose a reasonableness of surgical programs. The SLN was positioned using a handheld gamma detection probe during operation and with a certain reference value of SUV, can increase the accuracy of the neck dissecting range.