^(99m)Tc-PPM应用于肺肿瘤的显像和导向手术的研究

Clinical Practice of ^(99m)Tc-Peplimycin Imaging and Radio Guided Surgery for Lung Neopla sms

背景与目的:肉眼判断和冰冻切片病理检查是我们在术中判断肿瘤的良恶性及其侵袭范围的常规方法,但肉眼判断缺乏准确性,术中冰冻检查需要等待一段时间;而术中用手持式γ-探测仪(gamma-detectingprobe,GDP)判断肿瘤的浸润范围及转移程度,可以帮助术者快速准确地决定手术切除范围及治疗方案,使手术更加合理化及个体化。本研究以99mTc-培普利欧霉素(peplomycin,PPM)为肿瘤示踪剂,进行肺癌显像和放射性核素导向手术的初步临床研究。方法:对37例肺肿瘤患者注射99mTc-PPM,术前进行肺肿瘤的显像,以ROI(regionofinterest)法处理并计算T/NT;术中以手持式γ探测仪(GDP)对手术标本进行放射性探测,以正常肺组织为本底组织(NT)计算T/NT比值,以比值的高低来确定探测标本的性质。结果:良、恶性肿瘤对99mTc-PPM的摄取值(良性病变N/NT1.04±0.08,肺癌N/NT1.41±0.16)的差异有统计学意义(P<0.01);以良性病变T/NT的x±2s为判断良恶性病变的阈值,99mTc-PPM显像对肺癌诊断灵敏度为90%,特异性为87.5%,准确度为89.3%;应用GDP能够准确地探测出肿瘤的侵袭范围,并可以判定肿瘤的淋巴结转移情况,其灵敏度、特异性和准确率分别达到91.0%、88.0%和90.0%。结论:可以将99mTc-PPM作为肿瘤示踪剂对肿瘤进行术前诊断和术中GDP探测。

BACKGROUND &OBJECTIVE:Intraoperatively,the routine method to differentiate malig nant l ung neoplasms from benig n lesions is by the judg ment of naked eye or frozen section.It is not accurate to judg e by nake d eye and will take long time by frozen sect ion.Using a g amma-detecting probe (GDP)to accurately detect the tumors and t he metastases,the operators could decide the resection rang e and the tr eatment plan.This study was prelimi nary clinical practice of tumor imag ing a nd radioimmunog uided surg ery(RGS )using 99m Tc-PPM(peplomycin)as a tumor tracer.METHODS :Thirty-seven patients were administered with inj ection of 99m Tc-PPM.The imag es were taken preoperatively.Reg ion of interest (ROI )method was performed and tumor-to-normal-tissue(T /NT)ratio was calculated on the imag e.Th e radioactivity of the specimens resected from the patient s was detected using GDP at the time of surg ery.T /NT ratio was obtained by c omparing the radioactivity of the tu mor tissue with the normal lung tissue.RESULTS :The uptake ratios (T /NT)of 99m Tc-PPM were different between malig nant and benig n lesion(P<0.01).The ratio(T /NT,x±2s )was reg arded as the threshold for dif ferentiation of malig nant and benig n lesions.The sensitivity,specificity,and accuracy of ident ifying malig nant lesion were 90%,87.5%,an d 89.3%,respectively;GDP could be used to accurately detect the invasi ve rang e of the tumors,with the sensi tivity,specificity,and accuracy of identifying lymph node metastases of 91%,88%,and 90%,respectively.CONCLUSION:99m Tc-PPM is a useful ag ent in differentiating malig nant lung neo plasm from benig n lesions,and as a tu mor tracer can be used in detecting tumor by GDP intraoperatively.The RGS is a simple method that can help the surg e on in the intraoperative assessment of the tumor and the lymph node metastases.