Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Am J Ophthalmol. 2013 Jul;156(1):43-49.e2. doi: 10.1016/j.ajo.2013.02.015. Epub 2013 Apr 26.
To study the utility of hybrid single photon emission computed tomography / computed tomography (SPECT/CT) scan and dual-dye technique in identification of the sentinel lymph node (SLN) in patients with an advanced malignant eyelid tumor.
Nonrandomized prospective interventional study.
setting: A tertiary eye care center. study population: Patients with an advanced malignant eyelid tumor without clinically involved regional lymph nodes. intervention: SLN biopsy was performed using dual-dye technique (a combination of radiotracer and vital blue dye) following localization by SPECT/CT. main outcome measures: Localization of SLN in the regional node basin by hybrid SPECT/CT scan; SLN identification rate using dual-dye technique; SLN positivity rate; false-negative rate; and complications, if any, of SLN biopsy.
Sixteen patients of biopsy-proven eyelid malignancy (7 squamous cell carcinomas [43.75%], 5 sebaceous cell carcinomas [31.25%], and 4 malignant melanomas [25%]) were included in the study. Preoperative localization of SLN was performed using SPECT/CT in 12 patients. SLN biopsy using dual-dye technique was performed in 16 patients. SPECT/CT accurately localized SLN in 11 out of 12 patients. The preauricular region was the most common site of SLN. SLN identification rates for dual-dye, radiotracer, and blue dye techniques were 100% (16/16 patients), 100% (16/16 patients), and 87.5% (14/16 patients), respectively. SLN showed metastasis in 2 patients (12.5%). On follow-up, 1 patient developed cervical lymph node metastasis, thus giving a false-negative rate of 7.14%. There were no complications associated with SLN biopsy.
Accurate preoperative localization of SLN in relation to adjacent anatomic structures using SPECT/CT aids in intraoperative identification of SLN. SLN biopsy should be considered in patients with eyelid tumors at significant risk for metastasis who have clinically negative nodal basins. Dual-dye technique is safe and feasible in advanced eyelid tumors. Blue dye technique can be used for SLN biopsy in settings where nuclear medicine facilities are not available, albeit with a lower SLN identification rate. Detection of metastasis in SLNs in ∼12% of cases emphasizes the utility of SLN biopsy in accurate staging and treatment of eyelid malignancies.
研究混合单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）扫描和双染技术在诊断晚期恶性眼睑肿瘤患者前哨淋巴结（SLN）中的应用。
非随机前瞻性干预研究。
地点：一家三级眼科护理中心。研究人群：无临床区域淋巴结受累的晚期恶性眼睑肿瘤患者。干预措施：使用 SPECT/CT 定位后，采用双染技术（放射性示踪剂和生命蓝染料的组合）进行 SLN 活检。主要观察指标：混合 SPECT/CT 扫描对 SLN 在区域淋巴结盆中的定位；双染技术的 SLN 识别率；SLN 阳性率；假阴性率；以及 SLN 活检的任何并发症。
16 例经活检证实的眼睑恶性肿瘤患者（7 例鳞状细胞癌[43.75%]、5 例皮脂腺癌[31.25%]和 4 例恶性黑色素瘤[25%]）纳入本研究。12 例患者术前采用 SPECT/CT 进行 SLN 定位。16 例患者采用双染技术进行 SLN 活检。SPECT/CT 准确地对 12 例患者中的 11 例进行了 SLN 定位。最常见的 SLN 部位是耳前区。双染、放射性示踪剂和蓝色染料技术的 SLN 识别率分别为 100%（16/16 例患者）、100%（16/16 例患者）和 87.5%（14/16 例患者）。2 例患者（12.5%）的 SLN 显示转移。随访时，1 例患者出现颈部淋巴结转移，因此假阴性率为 7.14%。SLN 活检无相关并发症。
使用 SPECT/CT 对 SLN 与邻近解剖结构的关系进行准确的术前定位，有助于术中识别 SLN。对于临床淋巴结阴性但有明显转移风险的眼睑肿瘤患者，应考虑进行 SLN 活检。在晚期眼睑肿瘤中，双染技术是安全可行的。在没有核医学设备的情况下，也可以使用蓝色染料技术进行 SLN 活检，但 SLN 识别率较低。约 12%的病例中 SLN 转移的发现强调了 SLN 活检在准确分期和治疗眼睑恶性肿瘤中的作用。
