Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Nucl Med. 2010 Mar;51(3):376-82. doi: 10.2967/jnumed.109.071779. Epub 2010 Feb 11.
Paraaortic sentinel node biopsy may be a challenging procedure because the sentinel nodes are located retroperitoneally in close proximity to vital structures. The purpose of this study was to describe and evaluate the value of preoperative SPECT/CT for lymphatic mapping, and a portable gamma-camera for intraoperative radioguidance, in patients with paraaortic sentinel nodes.
We evaluated our practice in 18 patients, who were treated at The Netherlands Cancer Institute with sentinel lymphadenectomy for different urologic malignancies and showed paraaortic drainage on preoperative images. After intratumoral injection of (99m)Tc-nanocolloid, the patients underwent sequential planar lymphoscintigraphy, hybrid SPECT/CT, and sentinel lymphadenectomy. Intraoperative node detection and localization were guided by a laparoscopic gamma-probe and a portable gamma-camera. This gamma-camera was set to display both the (99m)Tc signal and the (125)I-seed signal. This (125)I seed was placed on top of the gamma-probe, functioning as a pointer on screen, thus enabling real-time sentinel node localization with the gamma-camera.
In 16 patients with midabdominal drainage on planar images and in 2 patients with nonvisualization on planar images, SPECT/CT showed clear localization of paraaortic sentinel nodes in relation to the abdominal vessels. Five patients underwent open surgery, and 13 patients underwent laparoscopy. The paraaortic sentinel nodes were successfully localized and removed in 15 patients with the help of the portable gamma-camera and gamma-probe and in 3 patients with the gamma-probe only. In 1 patient, the paraaortic sentinel node showed a metastasis.
If retroperitoneal drainage is expected, SPECT/CT provides good detection and clear localization of sentinel nodes in relation to anatomic structures. Detection and removal of paraaortic sentinel nodes by means of a laparoscopic gamma-probe and real-time imaging with a portable gamma-camera is a successful method with high intraoperative detection rates.
腹主动脉搏送淋巴结活检可能是一项具有挑战性的操作，因为前哨淋巴结位于腹膜后，与重要结构相邻。本研究旨在描述并评估术前 SPECT/CT 淋巴成像和便携式伽马相机在腹主动脉搏送前哨淋巴结患者中的应用价值。
我们评估了荷兰癌症研究所 18 例患者的治疗实践，这些患者因不同的泌尿科恶性肿瘤接受了前哨淋巴结切除术，且术前影像学显示腹主动脉旁引流。在肿瘤内注射（99m）Tc-纳米胶体后，患者接受了顺序平面淋巴闪烁显像、混合 SPECT/CT 和前哨淋巴结切除术。术中使用腹腔镜伽马探头和便携式伽马相机引导淋巴结检测和定位。该伽马相机被设置为同时显示（99m）Tc 信号和（125）I 种子信号。（125）I 种子放在伽马探头的顶部，在屏幕上充当指针，从而使伽马相机能够实时进行前哨淋巴结定位。
在 16 例平面图像显示中腹部引流和 2 例平面图像无显影的患者中，SPECT/CT 清晰地显示了腹主动脉旁前哨淋巴结与腹部血管的关系。5 例患者行开放手术，13 例患者行腹腔镜手术。在便携式伽马相机和伽马探头的帮助下，15 例患者成功定位并切除了腹主动脉旁前哨淋巴结，在 3 例患者中仅使用伽马探头即可定位并切除。在 1 例患者中，腹主动脉旁前哨淋巴结显示转移。
如果预计有腹膜后引流，SPECT/CT 可提供良好的检测效果，并清晰地定位与解剖结构相关的前哨淋巴结。通过腹腔镜伽马探头和实时成像的便携式伽马相机检测和切除腹主动脉搏送前哨淋巴结是一种成功率高、术中检测率高的方法。
