Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur J Nucl Med Mol Imaging. 2010 Jun;37(6):1117-23. doi: 10.1007/s00259-009-1359-7. Epub 2010 Jan 29.
Lymphatic drainage from renal cell carcinoma is unpredictable and the therapeutic benefit and extent of lymph node dissection are controversial. We evaluated the feasibility of intratumoural injection of a radiolabelled tracer to image and sample draining lymph nodes in clinically non-metastatic renal cell carcinoma.
Eight patients with cT1-2 cN0 cM0 (<6 cm) renal cell carcinoma prospectively received percutaneous intratumoural injections of (99m)Tc-nanocolloid under ultrasound guidance (0.4 ml, 225 MBq at one to four intratumoural locations depending on tumour size). Lymphoscintigraphy was performed 20 min, 2 h and 4 h after injection. After the delayed images a hybrid SPECT/CT was performed. SPECT was fused with CT to determine the anatomical localization of the sentinel node. Surgery with sampling was performed the following day using a gamma probe and a portable mini gamma camera.
Eight patients, seven with right-sided renal cell carcinoma, were included with a mean age of 55 years (range: 45-77). The mean tumour size was 4 cm (range: 3.5-6 cm). Six patients had sentinel nodes on scintigraphy (two retrocaval, four interaortocaval, including one hilar) with one extraretroperitoneal location along the internal mammary chain. All nodes could be mapped and sampled. In two patients no drainage was visualized. Renal cell carcinomas were of clear cell subtype with no lymph node metastases.
Sentinel node identification using preoperative and intraoperative imaging to locate and sample the sentinel node at surgery in renal cell carcinoma is feasible. Sentinel node biopsy may clarify the pattern of lymphatic drainage and extent of lymphatic spread which may have diagnostic and therapeutic implications.
肾细胞癌的淋巴引流是不可预测的，淋巴结清扫的治疗益处和范围存在争议。我们评估了在临床非转移性肾细胞癌中，向肿瘤内注射放射性标记示踪剂以对引流淋巴结进行成像和取样的可行性。
8 例 cT1-2 cN0 cM0（<6cm）肾细胞癌患者前瞻性地接受了超声引导下的（99m）Tc-纳米胶体经皮肿瘤内注射（根据肿瘤大小，在一个至四个肿瘤内位置注射 0.4ml，225MBq）。注射后 20min、2h 和 4h 进行淋巴闪烁显像。延迟显像后进行 SPECT/CT 混合显像。SPECT 与 CT 融合以确定前哨淋巴结的解剖定位。次日，使用伽马探针和便携式迷你伽玛相机进行手术取样。
8 例患者，7 例右侧肾细胞癌，平均年龄 55 岁（范围：45-77 岁）。肿瘤平均大小为 4cm（范围：3.5-6cm）。6 例患者在闪烁显像上有前哨淋巴结（2 例肾静脉后，4 例腹主动脉旁，包括 1 例 hilar），1 例额外的腹膜后位置沿内乳链。所有淋巴结均可定位和取样。2 例患者未观察到引流。肾细胞癌为透明细胞亚型，无淋巴结转移。
使用术前和术中成像来定位和取样手术中的前哨淋巴结，在肾细胞癌中识别前哨淋巴结是可行的。前哨淋巴结活检可以阐明淋巴引流的模式和淋巴扩散的程度，这可能具有诊断和治疗意义。
