Vermeeren Lenka, Valdés Olmos Renato A, Meinhardt Wim, Bex Axel, van der Poel Henk G, Vogel Wouter V, Sivro Ferida, Hoefnagel Cees A, Horenblas Simon
Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Nucl Med. 2009 Jun;50(6):865-70. doi: 10.2967/jnumed.108.060673. Epub 2009 May 14.
Laparoscopic evaluation of sentinel nodes is useful for staging prostate cancer, but preoperative localization of deep abdominal sentinel nodes with planar lymphoscintigraphy is difficult. We evaluated the value of SPECT/CT for detecting and localizing sentinel nodes in prostate cancer.
(99m)Tc-nanocolloid was injected peri- and intratumorally, guided by transrectal ultrasonography, in 46 patients with prostate cancer of intermediate prognosis. Patients underwent planar imaging after 15 min and 2 h, SPECT/CT after 2 h, and laparoscopic sentinel node lymphadenectomy on the same day. SPECT was fused with CT and analyzed using 2-dimensional orthogonal slicing and 3-dimensional volume rendering. We evaluated the number of extra sentinel nodes found by SPECT/CT, the number of sentinel nodes found by SPECT/CT outside the area of the extended pelvic lymphadenectomy, and the anatomic information provided by SPECT/CT. Furthermore, we classified the value of the additional SPECT/CT images into 3 categories (no advantage, presumable advantage, and definite advantage) according to the extra anatomic information given and whether additional sentinel nodes were found by SPECT/CT.
The patients had a mean age of 64 y (range, 53-74 y) and received a mean injected dose of 218 MBq (range, 147-286 MBq). The sentinel node visualization rate was 91% (42 patients) for planar imaging and 98% (45 patients) for SPECT/CT. In 29 of the 46 patients (63%), SPECT/CT revealed additional sentinel nodes (especially lymph nodes near the injection area) not seen on planar imaging. In 7 patients, those additional sentinel nodes were positive for metastasis (being the exclusive metastatic sentinel node in 4 patients). Overall, 15 patients (33%) had positive sentinel nodes. Sentinel nodes outside the area of extended pelvic lymphadenectomy were found in 16 patients (35%), whereas in 56% of these patients those nodes were not seen on planar imaging. Performing SPECT/CT had no advantage in 13% of the patients, a presumable advantage in 24%, and a definite advantage in 63%. Urologic surgeons used the SPECT/CT images to guide their trocar insertion sites and sentinel node finding with the probe.
More sentinel nodes can be detected with SPECT/CT than with planar imaging alone. In comparison with planar imaging, SPECT/CT especially reveals extra sentinel nodes near the prostate and outside the area of the extended pelvic lymphadenectomy. Furthermore, the modality provides useful additional information about the anatomic location of sentinel nodes within and outside the pelvic area, leading to improved intraoperative sentinel node identification.
腹腔镜评估前哨淋巴结对前列腺癌分期有用，但通过平面淋巴闪烁显像术对深部腹部前哨淋巴结进行术前定位困难。我们评估了SPECT/CT在检测和定位前列腺癌前哨淋巴结方面的价值。
在46例预后中等的前列腺癌患者中，经直肠超声引导下，于肿瘤周围和瘤内注射（99m）Tc-纳米胶体。患者在15分钟和2小时后进行平面显像，2小时后进行SPECT/CT检查，并于同日进行腹腔镜前哨淋巴结清扫术。SPECT与CT融合，并使用二维正交切片和三维容积再现进行分析。我们评估了SPECT/CT发现的额外前哨淋巴结数量、在扩大盆腔淋巴结清扫区域外由SPECT/CT发现的前哨淋巴结数量以及SPECT/CT提供的解剖信息。此外，根据所提供的额外解剖信息以及SPECT/CT是否发现额外前哨淋巴结，我们将额外SPECT/CT图像的价值分为3类（无优势、可能有优势和肯定有优势）。
患者的平均年龄为64岁（范围53 - 74岁），平均注射剂量为218 MBq（范围147 - 286 MBq）。平面显像的前哨淋巴结显影率为91%（42例患者），SPECT/CT为98%（45例患者）。在46例患者中的29例（63%），SPECT/CT显示出平面显像未发现的额外前哨淋巴结（尤其是注射区域附近的淋巴结）。在7例患者中，那些额外前哨淋巴结有转移阳性（4例患者中为唯一的转移前哨淋巴结）。总体而言，15例患者（33%）前哨淋巴结阳性。在16例患者（35%）中发现了扩大盆腔淋巴结清扫区域外的前哨淋巴结，而在这些患者中，56%的患者平面显像未发现这些淋巴结。13%的患者进行SPECT/CT无优势，24%可能有优势，63%肯定有优势。泌尿外科医生使用SPECT/CT图像来指导他们的套管针插入部位以及用探头寻找前哨淋巴结。
与单独的平面显像相比，SPECT/CT能检测到更多的前哨淋巴结。与平面显像相比，SPECT/CT尤其能显示前列腺附近和扩大盆腔淋巴结清扫区域外的额外前哨淋巴结。此外，该检查方式提供了关于盆腔内外前哨淋巴结解剖位置的有用额外信息，有助于术中更好地识别前哨淋巴结。
