Department of Surgery, University of Virginia Health Systems, Charlottesville, 22908, USA.
Ann Surg. 2011 Apr;253(4):774-8. doi: 10.1097/SLA.0b013e3181f9b709.
To evaluate the sensitivity and clinical utility of intraoperative mobile gamma camera (MGC) imaging in sentinel lymph node biopsy (SLNB) in melanoma.
The false-negative rate for SLNB for melanoma is approximately 17%, for which failure to identify the sentinel lymph node (SLN) is a major cause. Intraoperative imaging may aid in detection of SLN near the primary site, in ambiguous locations, and after excision of each SLN. The present pilot study reports outcomes with a prototype MGC designed for rapid intraoperative image acquisition. We hypothesized that intraoperative use of the MGC would be feasible and that sensitivity would be at least 90%.
From April to September 2008, 20 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and SLNB was performed with use of a conventional fixed gamma camera (FGC), and gamma probe followed by intraoperative MGC imaging. Sensitivity was calculated for each detection method. Intraoperative logistical challenges were scored. Cases in which MGC provided clinical benefit were recorded.
Sensitivity for detecting SLN basins was 97% for the FGC and 90% for the MGC. A total of 46 SLN were identified: 32 (70%) were identified as distinct hot spots by preoperative FGC imaging, 31 (67%) by preoperative MGC imaging, and 43 (93%) by MGC imaging pre- or intraoperatively. The gamma probe identified 44 (96%) independent of MGC imaging. The MGC provided defined clinical benefit as an addition to standard practice in 5 (25%) of 20 patients. Mean score for MGC logistic feasibility was 2 on a scale of 1-9 (1 = best).
Intraoperative MGC imaging provides additional information when standard techniques fail or are ambiguous. Sensitivity is 90% and can be increased. This pilot study has identified ways to improve the usefulness of an MGC for intraoperative imaging, which holds promise for reducing false negatives of SLNB for melanoma.
评估术中移动伽玛相机（MGC）成像在黑色素瘤前哨淋巴结活检（SLNB）中的敏感性和临床实用性。
黑色素瘤 SLNB 的假阴性率约为 17%，其中未能识别前哨淋巴结（SLN）是主要原因。术中成像可帮助检测靠近原发部位、位置不明确和切除每个 SLN 后的 SLN。本初步研究报告了一种设计用于快速术中图像采集的原型 MGC 的结果。我们假设术中使用 MGC 是可行的，并且灵敏度至少为 90%。
从 2008 年 4 月至 9 月，20 例患者接受了 Tc99 硫胶体淋巴闪烁显像，并用常规固定伽玛相机（FGC）、伽玛探针进行 SLNB，然后进行术中 MGC 成像。计算了每种检测方法的灵敏度。记录了术中逻辑挑战的评分。记录了 MGC 提供临床益处的病例。
FGC 检测 SLN 盆地的灵敏度为 97%，MGC 为 90%。共识别出 46 个 SLN：32 个（70%）通过术前 FGC 成像识别为明显热点，31 个（67%）通过术前 MGC 成像识别，43 个（93%）通过术前或术中 MGC 成像识别。伽玛探针在不依赖 MGC 成像的情况下识别出 44 个（96%）。MGC 在 20 例患者中的 5 例（25%）作为标准实践的附加手段提供了明确的临床益处。MGC 逻辑可行性的平均得分为 1-9 分制的 2 分（1 分为最佳）。
当标准技术失败或不明确时，术中 MGC 成像提供了额外的信息。灵敏度为 90%，并且可以提高。这项初步研究确定了提高术中成像用 MGC 实用性的方法，这有望减少黑色素瘤 SLNB 的假阴性率。
