Department of Plastic Surgery, St Johns Hospital, Howden Road West, Livingston, West Lothian, Scotland EH54 6PP, UK.
J Plast Reconstr Aesthet Surg. 2013 Sep;66(9):1248-55. doi: 10.1016/j.bjps.2013.04.062. Epub 2013 May 20.
Lymphoscintigraphy in melanoma provides important information on the dynamic drainage of the primary tumour and the location of the sentinel lymph node (SLN). Unfortunately these images lack anatomical detail. Single positron emission computed tomography/computed tomography (SPECT/CT) provides extremely detailed information on the location of the SLN and its relationship with surrounding structures and it is the aim of this study to report our initial experience with this technology.
Thirty-two patients undergoing sentinel lymph node biopsy (SLNB) at our unit between October 2010 and October 2011 were included in this study. In each case, conventional planar lymphoscintigraphy (PL) was followed by SPECT/CT. Images of each patient were reviewed by the operating consultant plastic surgeon and a consultant radiologist. A joint opinion was issued on the number of lymph nodes identified by each imaging modality and whether SPECT/CT influenced surgical approach.
Both PL and SPECT/CT detected the SLN in 31/32 patients. There was no significant difference between the number of SLN identified by PL and SPECT (p = 0.69). In relation to the true number of SLNs identified intra-operatively by gamma probing and blue dye, there was no statistically significant difference in accuracy between SPECT/CT and PL (p = 0.50). SPECT/CT was judged to provide useful anatomical information in all cases. Surgical approach was altered in 12/32 patients and contributed to the detection of SLNs that were positive for metastases.
In relation to true SLN number, SPECT/CT was not significantly more accurate than PL. The detailed anatomical information provided by SPECT/CT improved confidence and pre-operative planning in all patients. In select cases, particularly in the head and neck, SPECT/CT overcame the limitations of PL and facilitated the detection and sampling of metastatic nodes.
黑色素瘤淋巴闪烁显像术为原发性肿瘤的动态引流和前哨淋巴结 (SLN) 的位置提供了重要信息。不幸的是，这些图像缺乏解剖细节。单光子发射计算机断层扫描/计算机断层扫描 (SPECT/CT) 为 SLN 的位置及其与周围结构的关系提供了极其详细的信息，本研究旨在报告我们对此项技术的初步经验。
2010 年 10 月至 2011 年 10 月期间，我们单位有 32 名患者接受了前哨淋巴结活检 (SLNB)，这些患者均纳入本研究。在每例患者中，均先进行常规平面淋巴闪烁显像术 (PL)，然后进行 SPECT/CT。由手术顾问整形外科医师和顾问放射科医师对每位患者的图像进行审查。两位医师发表了关于两种成像方式所识别的淋巴结数量的联合意见，并发表了 SPECT/CT 是否影响手术方法的意见。
PL 和 SPECT/CT 均在 31/32 例患者中检测到 SLN。PL 和 SPECT 识别的 SLN 数量之间无显著差异 (p=0.69)。与术中伽马探测和蓝染所识别的真正 SLN 数量相比，SPECT/CT 和 PL 的准确性之间无统计学差异 (p=0.50)。SPECT/CT 在所有病例中均被认为提供了有用的解剖学信息。32 例患者中有 12 例手术方法发生改变，有助于检测出转移性 SLN。
与真正的 SLN 数量相比，SPECT/CT 并不显著更准确。SPECT/CT 提供的详细解剖学信息提高了所有患者的信心和术前计划。在某些特定病例中，特别是在头颈部，SPECT/CT 克服了 PL 的局限性，并有助于检测和采样转移性淋巴结。
