^(99)Tc^(m)-3PRGD2显像在甲状腺乳头状癌术前转移淋巴结诊断及手术方案制订中的价值

^(99)Tc^(m)-3PRGD2 SPECT/CT on Diagnosing Metastatic Lymph Nodes and Formulating Surgical Program in Preoperative Papillary Thyroid Carcinoma

目的探讨^(99)Tc^(m)-3PRGD2显像及其联合超声在预测甲状腺乳头状癌颈部淋巴结转移及手术方案制订中的应用价值。资料与方法前瞻性对2020年1月—2021年1月西安交通大学第一附属医院因甲状腺乳头状癌伴可疑淋巴结转移行手术治疗的28例患者(87个淋巴结,包括中央区32个、颈侧区55个),于术前超声检查后7 d内行^(99)Tc^(m)-3PRGD2 SPECT/CT显像。以术后病理为“金标准”,比较^(99)Tc^(m)-3PRGD2 SPECT/CT及超声预测颈部淋巴结转移的情况;比较^(99)Tc^(m)-3PRGD2 SPECT/CT、超声及二者联合预测颈部淋巴结转移的敏感度、特异度、准确度、阳性预测值与阴性预测值的差异,并比较影像学结果与病理、随访结果的一致性。结果中央区组病理确诊22个转移灶,10个良性病变。超声提示9个转移,SPECT/CT提示11个存在异常局灶性摄取。3PRGD2显像正确鉴别2个超声可疑转移,6个超声假阴性,1个超声假阳性。颈侧区组病理确诊38个转移灶,17个良性病变。超声提示34个转移,SPECT/CT提示25个存在异常局灶性摄取。3PRGD2显像正确鉴别8个超声可疑转移,5个超声假阴性,1个超声假阳性。基于此调整手术清扫范围,减少了病灶遗漏。两者联合诊断时,颈侧区组[89.47%、87.27%、77.78%、0.707(P<0.01)]及总体[80.00%、79.31%、63.64%、0.545(P<0.01)]的敏感度、准确度、阴性预测值和与病理随访结果的Kappa值均较单一检查升高,且差异有统计学意义(χ^(2)=6.483~18.157,P均<0.01)。结论在甲状腺乳头状癌术前超声提示异常淋巴结的良、恶性判断中,^(99)Tc^(m)-3PRGD2 SPECT/CT可降低超声假阴性率及假阳性率,联合超声可有效预测颈部淋巴结转移,对颈侧区淋巴结的预测可能更显著;在临床决策和手术方案制订中具有额外优势及增益价值。

Purpose To evaluate the value of^(99)Tc^(m)-3PRGD2 imaging combined with ultrasound on predicting cervical lymph node metastasis and formulating surgical program of papillary thyroid carcinoma(PTC).Materials and Methods From January 2020 to January 2021,28 PTC patients who were suspected of metastatic lymph nodes receiving surgery in the First Affiliated Hospital of Xi'an Jiaotong University were prospectively enrolled.^(99)Tc^(m)-3PRGD2 SPECT/CT imaging was performed among them within 7 days after preoperative ultrasound examination.A total of 87 nodes(32 in central region group,and 55 in cervical region group)were explored from all patients based on regional lymph nodes.Based on pathology as the gold standard,we aimed to compare^(99)Tc^(m)-3PRGD2 SPECT/CT imaging and ultrasound in predicting PTC cervical lymph node metastasis.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were compared,and the consistency of imaging results with pathological and follow-up results was evaluated as well.Results In the central region group,22 metastatic lesions and 10 benign lesions were confirmed by pathology.Ultrasound showed metastasis in 9 nodes,and 11 nodes had abnormal focal uptake via SPECT/CT.Two nodes of suspicious ultrasound metastasis,6 nodes of false ultrasound negative and 1 node of false ultrasound positive were identified correctly via 3PRGD2 imaging.In the cervical region group,38 metastatic lesions and 17 benign lesions were confirmed by pathology.Ultrasound showed metastasis in 34 nodes,and 25 nodes had abnormal focal uptake via SPECT/CT.The three indicators mentioned above were 8 nodes,5 nodes and 1 node,respectively.Based on the above,the range of lymph node dissections was adjusted to reduce the focus omission.In the cervical region groups[89.47%,87.27%,77.78%,0.707(P<0.01)]and whole[80.00%,79.31%,63.64%,0.545(P<0.01)],the sensitivity,accuracy,negative predictive value and Kappa value of combined diagnosis were significantly higher than these in any single test(χ^(2)=6.483-18.157,all P<0.01).Conclusion In the diagnosis of benign and malignant lymph nodes accompanied by abnormal ultrasound imaging in preoperative PTC patients,the false negative and positive rate of ultrasound could be reduced by using^(99)Tc^(m)-3PRGD2 SPECT/CT,and that combined with ultrasound might have a higher predictive value for lymph node metastasis,especially in cervical region.^(99)Tc^(m)-3PRGD2 SPECT/CT has additional advantages and gain value in clinical decision and formulating surgical program.