Zhang Wen-Jie, Zheng Rong, Wu Ling-Ying, Li Xiao-Guang, Li Bin, Chen Sheng-Zu
Department of Nuclear Medicine, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P. R. China.
Ai Zheng. 2006 Feb;25(2):224-8.
BACKGROUND & OBJECTIVE: Sentinel lymph node (SLN) identification has been increasingly used in the treatment design of a variety of solid tumors, particularly breast cancer and melanoma. A negative SLN predicts the absence of tumor metastases in the regional lymph nodes with high accuracy. This study was to investigate the clinical value of combined isotope-dye technique for detecting SLN, and to evaluate the accuracy of SLN in predicting the pelvic lymph nodes status in patients with early stage cervical cancer.
A total of 27 patients with early stage cervical cancer,scheduled for radical hysterectomy and total pelvic lymphadenectomy, were eligible for the study. Lymphoscintigraphy was performed with injection of radioactivity isotope (99m)Tc-labeled dextran ((99m)Tc-DX) into the uterine cervix 16 h before surgery. Methylthioninium (4 ml) was injected into the same points as (99m)Tc-DX during surgery, and the patients underwent lymphatic mapping with a handheld gamma-detecting probe. After resection of SLNs, standard radical hysterectomy with pelvic lymph node dissection was performed. All removed lymph nodes, including the SLNs, were examined by routine histopathology. The histopathologic results of SLNs and non-SLNs were compared.
The detection rates of SLN were 96.3% by blue dye method, and 100% by radiolabeled tracer or combined isotope-dye. Blue dye method identified 61 SLNs, radiolabeled tracer identified 69 SLNs, and combined isotope-dye identified 70 SLNs. Preoperative SPECT/CT fusion images detected 4 SLNs in the parametrium. Seven (25.9%) patients had lymph node metastasis. The sensitivity, accuracy, negative predictive value, and false negative rate of SLN detection were 85.7% (6/7), 96.3% (26/27), 95.2% (20/21), and 14.3% (1/7), respectively.
SPECT/CT imaging not only is superior to planar imaging in detecting SLN but also enables precise localization of SLNs. The combined isotope-dye method can improve the accuracy of SLN detection. SLN detection can accurately predict the pelvic lymph nodes status in early stage cervical cancer.
前哨淋巴结（SLN）识别在多种实体瘤尤其是乳腺癌和黑色素瘤的治疗设计中应用日益广泛。前哨淋巴结阴性可高度准确地预测区域淋巴结无肿瘤转移。本研究旨在探讨联合同位素-染料技术检测前哨淋巴结的临床价值，并评估前哨淋巴结在预测早期宫颈癌患者盆腔淋巴结状态方面的准确性。
共有27例计划行根治性子宫切除术及全盆腔淋巴结清扫术的早期宫颈癌患者纳入本研究。术前16小时将放射性同位素（99m）Tc标记的葡聚糖（（99m）Tc-DX）注入宫颈行淋巴闪烁显像。术中在与（99m）Tc-DX相同部位注入4毫升亚甲蓝，并用手持γ探测仪对患者进行淋巴绘图。切除前哨淋巴结后，行标准根治性子宫切除术及盆腔淋巴结清扫术。所有切除的淋巴结，包括前哨淋巴结，均进行常规组织病理学检查。比较前哨淋巴结与非前哨淋巴结的组织病理学结果。
蓝色染料法检测前哨淋巴结的检出率为9...%，放射性示踪剂或联合同位素-染料法的检出率为100%。蓝色染料法识别出61个前哨淋巴结，放射性示踪剂识别出69个前哨淋巴结，联合同位素-染料法识别出70个前哨淋巴结。术前SPECT/CT融合图像在子宫旁组织中检测到4个前哨淋巴结。7例（25.9%）患者有淋巴结转移。前哨淋巴结检测的敏感性、准确性、阴性预测值和假阴性率分别为85.7%（6/7）、96.3%（26/27）、95.2%（20/21）和14.3%（1/7）。
SPECT/CT成像在检测前哨淋巴结方面不仅优于平面成像，还能实现前哨淋巴结的精确定位。联合同位素-染料法可提高前哨淋巴结检测的准确性。前哨淋巴结检测可准确预测早期宫颈癌患者的盆腔淋巴结状态。 （注：原文中蓝色染料法检测率处数字缺失）
