Gallowitsch H-J, Kraschl P, Igerc I, Hussein T, Kresnik E, Mikosch P, Kohlfuerst S, Hausegger K, Lind P
Nuclear Medicine & Endocrinology, LKH Klagenfurt, St. Veiterstrasse 47, 9020 Klagenfurt, Austria.
Nuklearmedizin. 2007;46(6):252-6.
The AIM of this study was to determine the additional value of SPECT/CT in sentinel node scintigraphy in breast cancer. Furthermore, it was our question to determine, whether the low-dose computed tomography component (LD-CT) can be used for axillary lymph node staging of clinically negative patients.
PATIENTS, METHODS: 51 patients with invasive breast cancer <3 cm in diameter were included in our prospective investigation. SPECT/CT was performed on a dedicated scanner 30 minutes after subareolar injection of (99m)Tc-Nanocoll. Axillary staging with CT(LD) was performed using standard CT-criteria. SLN were allocated to an axillary level using SPECT alone and SPECT/CT. Additionally, the number of SLN on CT(LD) corresponding to the scintigraphic hot node was notified for each patient and compared to the number of SLN found with the gamma probe.
In 45/51 evaluable patients SLN could be localised in level I in 43 patients and in level II in two patients (all positive) using SPECT-CT, whereas a clear allocation could not be obtained by SPECT alone. The number of SLN was discrepant between SPECT and CT(LD) in 13/45 patients. The number of SLN detected with the gamma probe (n = 68) not significantly differed from the number of SLN detected by CT(LD) (n = 65) but was significantly higher than with SPECT (n = 51). CT(LD) yielded a sensitivity of 35.7%, a specificity of 83.9%, a positive predictive value (PPT) of 50%, a negative predictive value (NPV) of 74.3% and a diagnostic accuracy of 68.9% for axillary staging with CT(LD).
The additional information of SPECT/CT allows a more accurate characterization of the SN concerning size, depth and anatomical location. CT(LD) when performed during (99m)Tc-Nanocoll sentinel-SPECT/CT is not suitable for axillary staging in breast cancer patients with clinical negative axilla due to its low sensitivity and moderate specificity. Therefore, it does not influence the decision for SNB or ALND. The limited resolution of SPECT leads to an underestimation of the number of SLN compared to CT(LD) and the gamma probe.
本研究的目的是确定SPECT/CT在乳腺癌前哨淋巴结闪烁显像中的附加价值。此外，我们的问题是确定低剂量计算机断层扫描组件（LD-CT）是否可用于临床腋窝阴性患者的腋窝淋巴结分期。
患者、方法：51例直径<3 cm的浸润性乳腺癌患者纳入我们的前瞻性研究。在乳晕下注射（99m）Tc-纳米胶体30分钟后，在专用扫描仪上进行SPECT/CT检查。使用标准CT标准进行CT（LD）腋窝分期。仅使用SPECT和SPECT/CT将前哨淋巴结分配到腋窝水平。此外，记录每位患者CT（LD）上与闪烁显像热点相对应的前哨淋巴结数量，并与用γ探针发现的前哨淋巴结数量进行比较。
在45/51例可评估患者中，使用SPECT-CT可将43例患者的前哨淋巴结定位于I级，2例患者定位于II级（均为阳性），而仅通过SPECT无法获得明确的定位。13/45例患者的SPECT和CT（LD）之间的前哨淋巴结数量存在差异。用γ探针检测到的前哨淋巴结数量（n = 68）与CT（LD）检测到的前哨淋巴结数量（n = 65）无显著差异，但显著高于SPECT检测到的数量（n = 51）。CT（LD）对腋窝分期的敏感性为35.7%，特异性为83.9%，阳性预测值（PPT）为50%，阴性预测值（NPV）为74.3%，诊断准确性为68.9%。
SPECT/CT的附加信息可更准确地描述前哨淋巴结的大小、深度和解剖位置。在（99m）Tc-纳米胶体前哨SPECT/CT检查期间进行的CT（LD）由于其低敏感性和中等特异性，不适用于临床腋窝阴性的乳腺癌患者的腋窝分期。因此，它不影响前哨淋巴结活检或腋窝淋巴结清扫术的决策。与CT（LD）和γ探针相比，SPECT的分辨率有限导致前哨淋巴结数量被低估。
