Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
Department of Dermatology, Technische Universität München, Biedersteiner Str. 29, 80802 Munich, Germany.
Eur J Surg Oncol. 2014 Jan;40(1):42-8. doi: 10.1016/j.ejso.2013.09.005. Epub 2013 Sep 17.
The purpose of this study was to report on the first experiences with freehand single-photon emission-computed tomography (freehand SPECT) in sentinel lymph node biopsy (SLNB) in patients with malignant melanoma. Freehand SPECT is a novel imaging modality combining gamma probes, surgical navigation systems, and emission tomography algorithms, designed to overcome some of the limitations of conventional gamma probes.
In this study 20 patients with malignant melanoma underwent conventional planar scintigraphy prior to surgery. In the operating room, the number and location of separable SLNs were detected first by a pre-incisional scan with freehand SPECT to render a 3D-image of the target site and afterwards by a scan with a conventional gamma probe. After SLNB another scan was performed to document the removal of all targeted SLNs.
Planar scintigraphy identified 40 SLNs in 26 nodal basins. Pre-incisional freehand SPECT mapped 38 of these nodes as well as one additional node in one patient (95.0% node based sensitivity). The results of freehand SPECT were identical to those of planar scintigraphy in 25 basins, while it missed one basin (96.2% basin based sensitivity). In comparison, the gamma probe failed to detect 7 nodes in 4 basins (82.5% node based sensitivity and 84.6% basin based sensitivity). After resection freehand SPECT detected 9 remaining radioactive spots, two of whichwere resected as they matched the position of SLNs detected on preoperative planar scintigraphy.
Freehand SPECT provides a real-time, intraoperative 3D-image of the radioactive labelled SLNs, facilitating their detection and resection.
本研究旨在报告首例应用徒手单光子发射型计算机断层扫描（freehand SPECT）在恶性黑色素瘤前哨淋巴结活检（SLNB）中的应用经验。徒手 SPECT 是一种新的成像方式，结合了伽马探头、手术导航系统和发射断层扫描算法，旨在克服传统伽马探头的一些局限性。
本研究中，20 例恶性黑色素瘤患者在术前进行了常规平面闪烁扫描。在手术室中，首先通过徒手 SPECT 的预切口扫描检测可分离的 SLN 的数量和位置，以生成目标部位的 3D 图像，然后用传统的伽马探头进行扫描。SLNB 后，再进行一次扫描以记录所有靶向 SLN 的切除情况。
平面闪烁扫描在 26 个淋巴结区中识别出 40 个 SLN。预切口徒手 SPECT 定位了其中的 38 个淋巴结，在 1 例患者中还定位了另外 1 个淋巴结（95.0%基于淋巴结的灵敏度）。徒手 SPECT 的结果与平面闪烁扫描在 25 个淋巴结区完全一致，而在 1 个淋巴结区漏诊（96.2%基于淋巴结的灵敏度）。相比之下，伽马探头在 4 个淋巴结区中未能检测到 7 个淋巴结（82.5%基于淋巴结的灵敏度和 84.6%基于淋巴结区的灵敏度）。切除后，徒手 SPECT 检测到 9 个残留放射性点，其中 2 个因与术前平面闪烁扫描检测到的 SLN 位置相匹配而被切除。
徒手 SPECT 提供了实时的、术中 SLN 放射性示踪剂的 3D 图像，有助于其检测和切除。
