Kraft Otakar, Havel Martin
Clinic of Nuclear Medicine, University Hospital Ostrava, Ostrava, Czech Republic.
Nucl Med Rev Cent East Eur. 2013;16(1):17-25. doi: 10.5603/NMR.2013.0004.
Aim ot the study was to assess the role of planar lymphoscintigraphy and fusion imaging of SPECT/CT in sentinel lymph node (SLN) detection in patients with various types of tumours and to estimate some factors influencing detection success - age and body mass index.
Planar scintigraphy and hybrid modality SPECT/CT were performed in 550 consecutive patients (mean age 58.1 ± 13.1 years): 69 pts with gynaecological tumours (37 pts with cervical cancer, 25 pts with endometrial cancer, 7 pts with vulvar carcinoma; mean age 54.4 ± 13.2 years), 161 consecutive patients with melanomas (mean age 57.1 ± 14.8 years), and 320 consecutive women with breast cancer (mean age 59.4 ± 12.0 years). The radiopharmaceutical was injected around the tumour (gynaecologic and breast cancers, melanomas), subareolarly (in some breast cancers), or around the scar (in melanomas after their removal). Planar and SPECT/CT images were interpreted separately by two nuclear medicine physicians.
Planar scintigraphy did not show SLN in 77 patients (14.0%): in 8 pts with gynaecologic tumours, in 23 pts with melanomas and in 46 pts with breast cancer. SPECT/CT was negative in 49 patients (8.9%): in 4 pts with gynaecologic tumours, in 12 pts with melanomas and in 33 pts with breast cancer. In 199 (36.2%) patients the number of SLNs captured on SPECT/CT was higher than on planar imaging. 35 foci of uptake (3.1% from totally visible 1134 foci on planar images) interpreted on planar images as hot LNs were found to be false positive non-nodal sites of uptake when further assessed on SPECT/CT. SPECT/CT showed the exact anatomical location of all visualized sentinel nodes. Influence of the age and BMI: The group of patients with higher number of detected SLN on SPECT/CT than on planar scintigraphy had lower average age than the group of patients with the same number of detected SLN on SPECT/CT and on planar scintigraphy, the difference was statistically significant (P=0.008). BMI did not differ between the two groups.
In some patients with gynaecologic and breast cancers and melanomas, SPECT/CT improves detection of sentinel lymph nodes. It can image nodes not visible on planar scintigrams, exclude false positive uptake and exactly localize axillary, inguinal, pelvic and paraaortic SLNs. It improves anatomical localization of SLNs. We have found the influence of the age on the difference in the number of SLNs detected by the fusion of SPECT/CT and planar lymphoscintigraphy. On the other hand, this difference was not influenced by BMI.
本研究的目的是评估平面淋巴闪烁显像和SPECT/CT融合成像在各类肿瘤患者前哨淋巴结（SLN）检测中的作用，并评估一些影响检测成功率的因素——年龄和体重指数。
对550例连续患者（平均年龄58.1±13.1岁）进行了平面闪烁显像和混合模式SPECT/CT检查：69例妇科肿瘤患者（37例宫颈癌、25例子宫内膜癌、7例外阴癌；平均年龄54.4±13.2岁），161例连续黑色素瘤患者（平均年龄57.1±14.8岁），以及320例连续乳腺癌女性患者（平均年龄59.4±12.0岁）。放射性药物注射于肿瘤周围（妇科和乳腺癌、黑色素瘤）、乳晕下（部分乳腺癌）或瘢痕周围（黑色素瘤切除后）。平面和SPECT/CT图像由两名核医学医师分别解读。
平面闪烁显像在77例患者（14.0%）中未显示前哨淋巴结：8例妇科肿瘤患者、23例黑色素瘤患者和46例乳腺癌患者。SPECT/CT在49例患者（8.9%）中为阴性：4例妇科肿瘤患者、12例黑色素瘤患者和33例乳腺癌患者。在199例（36.2%）患者中，SPECT/CT捕获的前哨淋巴结数量高于平面显像。在平面图像上被解读为热淋巴结的35个摄取灶（占平面图像上全部可见的1134个灶的3.1%），在进一步通过SPECT/CT评估时被发现是假阳性的非淋巴结摄取部位。SPECT/CT显示了所有可视化前哨淋巴结的确切解剖位置。年龄和BMI的影响：SPECT/CT检测到的前哨淋巴结数量高于平面闪烁显像的患者组的平均年龄低于SPECT/CT和平面闪烁显像检测到的前哨淋巴结数量相同的患者组，差异具有统计学意义（P=0.008）。两组之间的BMI没有差异。
在一些妇科和乳腺癌以及黑色素瘤患者中，SPECT/CT可提高前哨淋巴结检测率。它可以成像平面闪烁显像中不可见的淋巴结，排除假阳性摄取，并准确地定位腋窝、腹股沟、盆腔和腹主动脉旁前哨淋巴结。它改善了前哨淋巴结的解剖定位。我们发现年龄对SPECT/CT与平面淋巴闪烁显像融合检测到的前哨淋巴结数量差异有影响。另一方面，这种差异不受BMI影响。
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