Spanu A, Tanda F, Dettori G, Manca A, Chessa F, Porcu A, Falchi A, Nuvoli S, Madeddu G
Department of Nuclear Medicine, University of Sassari, Sassari, Italy.
Q J Nucl Med. 2003 Jun;47(2):116-28.
We evaluated the usefulness of (99m)Tc-tetrofosmin axillary pinhole (P)-SPECT in breast cancer (BC) non palpable axillary lymph node metastasis detection compared with conventional planar and SPECT scintimammography.
We studied prospectively 188 consecutive patients with suspected primary BC, negative at axillary clinical examination. Ten minutes after 740 MBq (99m)Tc-tetrofosmin injection, planar and SPECT scintimammography were acquired, followed by axillary P-SPECT imaging.
At histology, 12 patients had benign mammary lesions and 176 had BC. Axillary lymph node dissection (ALND) was performed in all BC patients, bilaterally in 3 cases: 74/179 axillae had metastases. P-SPECT showed a significantly higher overall sensitivity than SPECT and planar (93.2% vs 85.1% and 36.5%, respectively; p<0.05 and p<0.0005, respectively) and was false negative in 5 patients with 1 metastatic node each, micrometastatic in 4/5 cases; SPECT and planar were also false negative in these 5 cases and in 6 and in 42 further cases, respectively. P-SPECT added important prognostic information by distinguishing single from multiple and pound 3 from >3 nodes; only P-SPECT defined the exact number of nodes in 15/25 patients with 2-4 nodes. P-SPECT showed the highest accuracy and NPV: 92.7% and 95%, respectively (SPECT 90.5% and 90%, respectively; planar 73.2% and 68.9%, respectively).
(99m)Tc-tetrofosmin axillary P-SPECT appears highly accurate in BC non palpable axillary lymph node metastasis detection and significantly more sensitive than both planar and SPECT, its few false negative results predominantly concerning micrometastases; moreover, only P-SPECT gave additional important prognostic information. Given its very high NPV, P-SPECT could also be used to better select patients who might avoid ALND.
我们评估了与传统平面乳腺闪烁显像及单光子发射计算机断层扫描（SPECT）乳腺闪烁显像相比，（99m）锝 - 替曲膦腋下针孔（P）-SPECT在检测乳腺癌（BC）不可触及的腋下淋巴结转移方面的实用性。
我们前瞻性地研究了188例连续的疑似原发性乳腺癌患者，其腋下临床检查为阴性。注射740MBq（99m）锝 - 替曲膦10分钟后，进行平面及SPECT乳腺闪烁显像，随后进行腋下P-SPECT成像。
组织学检查显示，12例患者有良性乳腺病变，176例有乳腺癌。所有乳腺癌患者均进行了腋下淋巴结清扫术（ALND），3例为双侧清扫：179个腋下中有74个有转移。P-SPECT显示总体敏感性显著高于SPECT和平面显像（分别为93.2%、85.1%和36.5%；p分别<0.05和<0.0005），5例各有1个转移淋巴结的患者为假阴性，其中4/5病例为微转移；这5例患者中SPECT和平面显像也为假阴性，另外还有6例和42例患者分别为假阴性。P-SPECT通过区分单个与多个淋巴结以及3个以下与3个以上淋巴结增加了重要的预后信息；在25例有2 - 4个淋巴结的患者中，只有P-SPECT确定了15例患者的确切淋巴结数量。P-SPECT显示出最高的准确性和阴性预测值：分别为92.7%和95%（SPECT分别为90.5%和90%；平面显像分别为73.2%和68.9%）。
（99m）锝 - 替曲膦腋下P-SPECT在检测乳腺癌不可触及的腋下淋巴结转移方面似乎高度准确，且比平面显像和SPECT均显著更敏感，其少数假阴性结果主要涉及微转移；此外，只有P-SPECT提供了额外的重要预后信息。鉴于其非常高的阴性预测值，P-SPECT也可用于更好地选择可能避免进行腋下淋巴结清扫术的患者。
