Brenot-Rossi Isabelle, Rossi Dominique, Esterni Benjamin, Brunelle Serge, Chuto Guillaume, Bastide Cyrille
Department of Nuclear Medicine, Institut Paoli-Calmettes, Regional Cancer Center, Université de la Méditerranée, 232 Bd. Sainte Marguerite, 13273, Marseille Cedex 9, France.
Eur J Nucl Med Mol Imaging. 2008 Jan;35(1):32-8. doi: 10.1007/s00259-007-0516-0. Epub 2007 Sep 9.
The purpose of this study was to determine the role of the injected dose of tracer in the non-detection of pelvic sentinel lymph nodes (SLN) in patients with prostate carcinoma.
Data were evaluated from 100 patients (age range 43-77, mean 63 years). The first 72 patients (group 1) received 2 x 0.3 ml of 30 MBq-nanocolloid-99 mTc and the remaining 28 patients (group 2) received 2 x 0.3 ml of 100 MBq. Surgery consisted of the detection and dissection of lymph nodes identified as sentinel nodes, followed by an extended lymphadenectomy.
SLNs were located in the interiliac group in 54.2% of patients, in the obturator fossa in 30.7%, in the external iliac group in 10.9% and in the common iliac group in 4.2% of cases. Lymph node involvement was observed in 12% of patients. But there was a 30.6% (22/72) failure rate of the SLN procedure in group 1 and 7.1% (2/28) in group 2. An increased risk of unsuccessful SLN procedure was statistically associated with the low dose of MBq-nanocolloids (p < 0.017). Statistical correlation is also found after the exclusion of the first 30 patients from the study (learning phase of the team) (p < 0.034). None of the other parameters showed a statistical association (age, p < 0.9; Gleason score, p < 0.3; grade pT, p < 0.7). A higher grade or a greater extension of cancer inside the prostate are not responsible for the failure of the SLN procedure.
It seems necessary to inject at least 200 MBq inside the prostate to avoid a failed SLN procedure.
本研究的目的是确定示踪剂注射剂量在前列腺癌患者盆腔前哨淋巴结（SLN）未被检测到中的作用。
对100例患者（年龄范围43 - 77岁，平均63岁）的数据进行评估。前72例患者（第1组）接受2×0.3 ml的30 MBq纳米胶体 - 99mTc，其余28例患者（第2组）接受2×0.3 ml的100 MBq。手术包括检测和解剖被确定为前哨淋巴结的淋巴结，随后进行扩大淋巴结清扫术。
54.2%的患者前哨淋巴结位于髂间组，30.7%位于闭孔窝，10.9%位于髂外组，4.2%位于髂总组。12%的患者观察到淋巴结受累。但第1组前哨淋巴结手术失败率为30.6%（22/72），第2组为7.1%（2/28）。前哨淋巴结手术失败风险增加与低剂量的MBq纳米胶体在统计学上相关（p < 0.017）。在排除研究中的前30例患者（团队学习阶段）后也发现了统计学相关性（p < 0.034）。其他参数均未显示统计学相关性（年龄，p < 0.9；Gleason评分，p < 0.3；pT分级，p < 0.7）。前列腺内癌症的更高分级或更大范围不是前哨淋巴结手术失败的原因。
似乎有必要在前列腺内注射至少200 MBq以避免前哨淋巴结手术失败。
