Sherif Amir, Garske Ulrike, de la Torre Manuel, Thörn Magnus
Department of Urology, Uppsala University Hospital, Uppsala, Sweden.
Eur Urol. 2006 Jul;50(1):83-91. doi: 10.1016/j.eururo.2006.03.002. Epub 2006 Mar 20.
To explore the feasibility of performing lymphoscintigraphy combined with computed tomography (CT) for preoperative detection of sentinel lymph nodes in patients with invasive bladder cancer.
Six consecutive patients scheduled for radical cystectomy underwent lymphoscintigraphy after transurethral injection of Albures-technetium 99m in the detrusor muscle peritumourally both with planar imaging and with single-photon emission computed tomography/CT (SPECT/CT). CT for anatomic fusion was performed directly after the SPECT/CT and both investigations were combined to a fused image. Radical cystectomy started with extended lymphadenectomy and intraoperative detection of sentinel nodes with both Geiger probe and dye marker. The conventional planar lymphoscintigraphies and the fused SPECT/CT were compared with each other and with the outcome of intraoperative sentinel node detection and final histopathologic analyses.
The method allowed anatomically detailed preoperative visualisation of 21 sentinel nodes in five of the six patients, whereas planar pictures only visualised two sentinel nodes in two of six patients. Two patients had lymph node metastases and in the other four the nodes were negative. The combined method visualised all metastatic sentinel nodes, whereas planar lymphoscintigraphy detected only one of six node metastases.
The combination of lymphoscintigraphy with CT enhanced preoperative anatomic localisation of sentinel nodes in bladder cancer and aided in the identification of sentinel nodes during surgery. The yield of detected sentinel nodes, both metastatic and nonmetastatic, was markedly increased using the combined method compared to conventional planar lymphoscintigraphy.
探讨淋巴管造影联合计算机断层扫描（CT）用于浸润性膀胱癌患者术前前哨淋巴结检测的可行性。
6例计划行根治性膀胱切除术的患者，经尿道在肿瘤周围逼尿肌内注射锝99m标记的白蛋白后，接受了淋巴管造影，包括平面成像和单光子发射计算机断层扫描/CT（SPECT/CT）。SPECT/CT检查后直接进行用于解剖融合的CT检查，并将两项检查合并为融合图像。根治性膀胱切除术始于扩大淋巴结清扫术，并术中使用盖革探测器和染料标记物检测前哨淋巴结。将传统的平面淋巴管造影和融合的SPECT/CT相互比较，并与术中前哨淋巴结检测结果和最终组织病理学分析结果进行比较。
该方法使6例患者中的5例在术前获得了21个前哨淋巴结的详细解剖可视化图像，而平面图像仅在6例患者中的2例中显示了2个前哨淋巴结。2例患者有淋巴结转移，另外4例患者的淋巴结为阴性。联合方法显示了所有转移性前哨淋巴结，而平面淋巴管造影仅检测到6个淋巴结转移中的1个。
淋巴管造影与CT相结合增强了膀胱癌术前前哨淋巴结的解剖定位，并有助于手术中前哨淋巴结的识别。与传统平面淋巴管造影相比，联合方法显著提高了转移性和非转移性前哨淋巴结的检出率。
