Ishihara Tsuyoshi, Kaguchi Atsushi, Matsushita Shigeto, Shiraishi Shinya, Tomiguchi Seiji, Yamashita Yasuyuki, Kageshita Toshiro, Ono Tomomichi
Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-0811, Japan.
Int J Clin Oncol. 2006 Jun;11(3):214-20. doi: 10.1007/s10147-005-0554-1.
The differentiation of true sentinel lymph nodes from nonsentinel lymph nodes is difficult in cases of multiple radiolabeled or dyed lymph nodes.
We examined the locations of sentinel lymph nodes in melanoma and other malignant skin tumors by using dynamic lymphoscintigraphy and the single-photon-emission computed tomography/computed tomography (SPECT/CT) combined system.
Sentinel lymph nodes were detected in 45 of the 53 patients examined using only the ordinary blue dye method (85%), and were detected in all 35 patients examined using the SPECT/CT method (100%). Twenty of the 35 patients mentioned above had one sentinel lymph node. Multiple sentinel lymph nodes were demonstrated in the head and neck areas using the SPECT/CT method. Significant differences (P=0.0015) in the numbers of sentinel lymph nodes were found between the blue dye method only and the SPECT/CT method in the neck area. Popliteal sentinel lymph nodes were recognized in three patients, and cubital sentinel lymph nodes were recognized in two patients. Two patients had plural regional lymph nodes: one had popliteal and groin sentinel lymph nodes, while the other had cubital and axillary sentinel lymph nodes. The probe counts of the popliteus and cubitus were significantly lower (P=0.0241) than the counts in the groin, axilla, and neck areas. Micrometastatic sentinel lymph nodes were recognized in four patients, and two patients had metastases in both sentinel and nonsentinel lymph nodes.
Dynamic lymphoscintigraphy was useful when we were concerned about cubital and popliteal lymph nodes. The SPECT/CT combined system was useful in recognizing the anatomical location of sentinel lymph nodes before biopsy. The detection rate of sentinel lymph nodes using the SPECT/CT method was always better than that with the blue dye method (P=0.0197).
在多个放射性标记或染色淋巴结的情况下，区分真正的前哨淋巴结和非前哨淋巴结很困难。
我们使用动态淋巴闪烁显像和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）联合系统检查黑色素瘤和其他恶性皮肤肿瘤中前哨淋巴结的位置。
在仅使用普通蓝色染料法检查的53例患者中，有45例检测到前哨淋巴结（85%），在使用SPECT/CT法检查的所有35例患者中均检测到前哨淋巴结（100%）。上述35例患者中有20例有一个前哨淋巴结。使用SPECT/CT法在头颈部区域发现多个前哨淋巴结。在颈部区域，仅蓝色染料法和SPECT/CT法在前哨淋巴结数量上存在显著差异（P = 0.0015）。在3例患者中识别出腘窝前哨淋巴结，在2例患者中识别出肘前哨淋巴结。2例患者有多个区域淋巴结：1例有腘窝和腹股沟前哨淋巴结，另1例有肘前和腋窝前哨淋巴结。腘窝和肘部的探头计数明显低于腹股沟、腋窝和颈部区域的计数（P = 0.0241）。在4例患者中识别出微转移前哨淋巴结，2例患者在前哨淋巴结和非前哨淋巴结中均有转移。
当我们关注肘前和腘窝淋巴结时，动态淋巴闪烁显像很有用。SPECT/CT联合系统在活检前识别前哨淋巴结的解剖位置方面很有用。使用SPECT/CT法检测前哨淋巴结的检出率总是优于蓝色染料法（P = 0.0197）。
