SPECT/CT同机融合显像在cN0口腔鳞癌颈淋巴清扫术中的应用

Application of SPECT/CT co-registration fusion scintigraphy in neck dissection of cN0 oral squamous cell carcinoma

目的探讨SPECT/CT同机融合显像技术对确定c N0口腔鳞癌患者颈部淋巴结清扫范围的指导意义。方法选取20例c N0口腔鳞癌患者,运用SPECT/CT同机融合显像技术对其进行前哨淋巴结显像和横断位、冠状位、矢状位三维解剖定位,将显像及定位的前哨淋巴结划分为Ⅰ、Ⅱ、Ⅲ、Ⅳ区域,肿瘤原发灶切除术中对前哨淋巴结所在的区域进行颈淋巴清扫术,并对清扫出的前哨淋巴结进行冰冻检验,根据前哨淋巴结有无癌转移情况确定是否扩大颈部淋巴结清扫范围。结果 20例患者术前同机融合显像均能检出1-3枚前哨淋巴结,并能在三维图像中确定准确的解剖位置,检出率为100%,平均1.9枚/例。术中按解剖定位对所在的区域进行清扫,全部清扫出前哨淋巴结,冰冻活检发现5例患者的前哨淋巴结有癌转移,转移率25%。对此5例前哨淋巴结有癌转移的患者扩大至单侧全颈部淋巴结清扫,术后病理发现前哨淋巴结以外区域淋巴结癌转移者2例,占40%;另外15例前哨淋巴结未发现癌转移的患者则仅限于前哨淋巴结所在区域的清扫而不再扩大清扫范围。所有患者术后随访1-3年,均未发现颈部淋巴结复发或转移。结论 SPECT/CT同机融合显像可以在三维平面准确定位前哨淋巴结,前哨淋巴的癌转移情况对确定c N0口腔鳞癌患者颈淋巴清扫术的清扫范围有重要指导价值。

Objective To explore the application of SPECT / CT co-registration fusion scintigraphy in neck dissection of c N0 oral squamous cell carcinoma（ OSCC）. Methods A total of 20 c N0 patients with oral squamous cell carcinoma were be collected. Their sentinel lymph nodes（ SLN） were localized by SPECT / CT Co-registration Fusion Scintigraphy,then the localized nodes were divided into Ⅰ,Ⅱ,Ⅲ and Ⅳ area and to be deal with dissection and frozen biopsy. Finally every patient＇s neck dissection region needed depends on the result of the sentinel lymph node biopsy. Results In all the 20 cases,one to three sentinel lymph nodes were detected by SPECT / CT co-registration fusion scintigraphy in every case. The detection rate was 100% and the average case had 1. 9 sentinel lymph nodes to be found. During surgery all sentinel lymph nodes were dissected in the 20 cases by reference to the SPECT / CT co-registration fusion scintigraphy and sentinel lymph nodes positive were found in 5 cases by frozen biopsy. Among the 5 cases,additional nodes of 2 cases were found positive except sentinel lymph node. All the cases were followed up for one to three years and there were no recurrence or metastasis. Conclusion SPECT / CT co-registration fusion scintigraphy plays a important role in neck dissection of c N0 oral squamous cell carcinoma because it can be used to accurately locate sentinel lymph node in 3D Graphics before the operation.