Vidal-Sicart S, Brouwer O Roberto, Valdés-Olmos R A
Servei de Medicina Nuclear, Hospital Clínic Barcelona, Institut d'Investigació Biomèdica Agustí Pi i Sunyer, España.
Rev Esp Med Nucl. 2011 Sep-Oct;30(5):331-7. doi: 10.1016/j.remn.2011.05.009. Epub 2011 Jul 23.
The sentinel node biopsy procedure is based on the hypothesis of the existence of an orderly and predictable pattern of lymphatic drainage to a regional lymph node basin. This results in the consideration of all lymph nodes with direct drainage from the primary tumor as sentinel nodes. The sentinel node is not necessarily the hottest or the most nearby node, although this is often the case. Lymphoscintigraphy has been an essential component for preoperative sentinel node identification. With the new generation of multimodality gamma cameras, SPECT/CT has been incorporated into the sentinel node procedure. The resulting SPECT/CT fused images depict sentinel nodes in an anatomical landscape providing a helpful roadmap for surgeons. Therefore, it is necessary to define the role of SPECT/CT in relation to the classical planar lymphoscintigraphy for the identification of sentinel nodes. To understand the combined use of lymphoscintigraphy and SPECT/CT, the criteria for sentinel node identification on preoperative images must be specified. The authors, based on their experience in this field, present tentative criteria to identify lymph nodes as sentinel nodes both in planar and SPECT/CT images and classify them into different categories. The use of these scintigraphic categories to characterize radioactive lymph nodes is also helpful for surgical decision making.
前哨淋巴结活检程序基于这样一种假设，即存在一种有序且可预测的淋巴引流模式至区域淋巴结区。这导致将所有直接引流自原发肿瘤的淋巴结视为前哨淋巴结。前哨淋巴结不一定是最“热”或最靠近的淋巴结，尽管通常情况如此。淋巴闪烁显像一直是术前识别前哨淋巴结的重要组成部分。随着新一代多模态伽马相机的出现，SPECT/CT已被纳入前哨淋巴结程序。由此产生的SPECT/CT融合图像在解剖背景下描绘前哨淋巴结，为外科医生提供了有用的路线图。因此，有必要确定SPECT/CT相对于传统平面淋巴闪烁显像在识别前哨淋巴结方面的作用。为了理解淋巴闪烁显像和SPECT/CT的联合应用，必须明确术前图像上前哨淋巴结识别的标准。作者基于他们在该领域的经验，提出了在平面图像和SPECT/CT图像上识别淋巴结作为前哨淋巴结的初步标准，并将它们分类为不同类别。使用这些闪烁显像类别来表征放射性淋巴结也有助于手术决策。
