肺肿瘤放射导向手术的研究

Clinical trial of radioguided surgery for lung tumors

目的:研究放射导向手术在肺肿瘤手术上的应用。方法:对22例肺肿瘤患者术前静脉注射740MBq99mTc-MIBI作为示踪剂,术中持手握式γ探测器测量肿瘤、淋巴结及正常肺组织的在体和离体计数,根据计数的差异判定肿瘤的良恶性、淋巴结有无转移,并与病理结果比较,计算其灵敏度、特异度和准确度。结果:所有肿瘤均能准确定位,其中有2例腺癌患者探测出肺内直径小于1cm的隐匿性转移灶。对肺良恶性肿瘤定性诊断的灵敏度、特异度、准确度分别为88.9%,50.0%,81.8%;探测淋巴结是否有癌转移的灵敏度、特异度、准确度分别为52.4%,96.4%,84.4%。结论:放射导向手术对肿瘤定性诊断的灵敏度高而特异度较低;判断淋巴结有无转移的灵敏度较低而特异度很高。放射导向手术在肺外科的应用尚待进一步积累经验。

Objective:To investigate the role of radioguided surgery (RGS)in lung tumors.Materials and Methods:740MBq Technetium-99m-MIBI were injected intravenously as tracer in22cases with operable lung tumor .One hour before operation,the radioactivity were measured from the tumors,lymph nodes and normal tissues by aγ-detector both in vivo and in vitro.The malignancy and lymph node metastasis were assessed by the difference in count number,and correlated with pathological results.The sensitivity,sepecificity and accuracy were calculated accordingly.Results:All the tumors could be lo-calized intraoperatively.Occult metastasis with maximum diameter less than1cm was detected in two cases with lung adeno-carcinoma .Regarding the nature of lung tumor ,the sensitivity,specificity and accuracy were88.9%,50.0%,81.8%respec-tively.When it came to the assessment of lymph node metastasis,the results were52.4%,96.4%,84.4%respectively.Con-clusion:RGS presents higher sensitivity but lower specificity in the differential diagnosis of lung tumor ;higher specificity but low sensitivity for the assessment of lymph node metastasis.Large clinical studies are required to further assess the value of RGS in thoracic surgery.