Martínez Castillo R, Fernández López R, Acevedo Bañez I, Alvarez Pérez R M, García Solis D, Vázquez Albertino R, Fernández Ortega P
Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España.
Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rev Esp Med Nucl Imagen Mol. 2014 May-Jun;33(3):129-35. doi: 10.1016/j.remn.2013.07.012. Epub 2013 Oct 2.
To assess the contribution of SPECT-CT lymphoscintigraphy in selective sentinel lymph node biopsy (SLNB) in patients with newly diagnosed malignant melanoma.
A prospective study was made between July 2009 and October 2010. It included 63 patients diagnosed with melanoma (32 men and 31 women) with mean age of 55 years (range: 25-88) and inclusion criteria for SLNB. The melanomas were located as follows: 28 in trunk, 5 in head and neck, 16 in upper limbs and 17 in lower limbs. Three patients had two melanomas. Preoperative lymphoscintigraphy was performed after pericicatricial/perilesional injection of 74MBq of (99m)Tc-labeled nanocolloid human serum albumin, obtaining early planar images, late whole body study and sectorial images and SPECT-CT in the area of interest. Planar scintigraphy findings were compared with SPECT-CT.
The sentinel node (SN) was localized by planar imaging in 62/63 (98%) of patients. SPECT-CT study located the SN in all the patients with a detection rate of 100%. The number of SNs detected with SPECT-CT was higher than with the planar study in 27 patients. The SPECT-CT provided additional information (change in location and/or in its accuracy in the localization of location uncertain SN) in 14/63 (22.2%) patients, involving changes in the surgical approach and lymph node staging.
SPECT-CT detects a higher number of SN than planar lymphoscintigraphy in patients with melanoma. Its contribution is more relevant in the melanomas located on the trunk, head and neck. SPECT-CT modified the SN location by 22% compared to planar scan findings, facilitating a correct surgical approach.
评估SPECT-CT淋巴闪烁显像在新诊断恶性黑色素瘤患者选择性前哨淋巴结活检（SLNB）中的作用。
于2009年7月至2010年10月进行了一项前瞻性研究。研究纳入了63例诊断为黑色素瘤的患者（32例男性和31例女性），平均年龄55岁（范围：25-88岁），符合SLNB的纳入标准。黑色素瘤的分布如下：躯干28例，头颈部5例，上肢16例，下肢17例。3例患者有两处黑色素瘤。术前在瘢痕周围/病变周围注射74MBq的（99m）Tc标记的纳米胶体人血清白蛋白后进行淋巴闪烁显像，获取早期平面图像、晚期全身图像和感兴趣区域的扇形图像以及SPECT-CT图像。将平面闪烁显像结果与SPECT-CT结果进行比较。
63例患者中有62例（98%）通过平面显像定位到了前哨淋巴结（SN）。SPECT-CT研究在所有患者中均定位到了SN，检出率为100%。27例患者中，SPECT-CT检测到的SN数量多于平面显像。SPECT-CT为14/63（22.2%）的患者提供了额外信息（位置改变和/或定位不确定的SN的定位准确性改变），涉及手术方式和淋巴结分期的改变。
在黑色素瘤患者中，SPECT-CT检测到的SN数量多于平面淋巴闪烁显像。其作用在位于躯干、头颈部的黑色素瘤中更为显著。与平面扫描结果相比，SPECT-CT使SN位置改变了22%，有助于正确的手术方式。
