Brouwer Oscar R, Noe A, Olmos Renato A Valdés, Bex Axel
1 Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands .
Lymphat Res Biol. 2013 Dec;11(4):233-8. doi: 10.1089/lrb.2013.0017.
Lymphatic drainage of renal cell carcinoma is unpredictable. Renal lymphatics directly joining the thoracic duct without traversing any lymph nodes have been described in cadaver studies, yet to date, this has never been visualized using functional imaging in vivo.
Patients with renal tumors <10 cm (cT1-cT2) and clinical absence of metastases (cN0, cM0) took part in a prospective institutional review board approved study investigating sentinel node mapping. After ultrasound-guided percutaneaus intratumoral injection of (99m)Tc-nanocolloid (0.4 mL, 200 MBq) the day before surgery, planar sequential lymphoscintigraphy was obtained after 20 min and 2-4 h. Subsequently, SPECT/CT imaging was performed. Of 42 patients, 4 showed early lymphatic drainage following the course of the thoracic duct on lymphoscintigraphy and SPECT/CT images. In one patient, this was observed without any retroperitoneal lymph node interposition. In relation to patients with sentinel nodes on SPECT imaging the frequency of this drainage pattern was (4/22) 18.2%.
SN mapping of renal tumors using functional imaging modalities such as lymphoscintigraphy and SPECT/CT enables identification and sampling of sentinel nodes outside the area of routine dissection. Direct aberrant drainage through the thoracic duct can be observed in vivo as demonstrated in this study. This may support a hypothesis for certain anatomical metastatic sites and the failure to demonstrate a survival benefit of retroperitoneal lymph node dissections in renal cell carcinoma.
肾细胞癌的淋巴引流不可预测。尸体研究中已描述了肾淋巴管直接汇入胸导管而不经过任何淋巴结的情况，但迄今为止，尚未在活体中通过功能成像观察到这种情况。
肾肿瘤<10 cm（cT1 - cT2）且临床无转移（cN0，cM0）的患者参与了一项前瞻性机构审查委员会批准的前哨淋巴结定位研究。术前一天在超声引导下经皮瘤内注射（99m）Tc - 纳米胶体（0.4 mL，200 MBq）后，分别于20分钟和2 - 4小时进行平面序贯淋巴闪烁显像。随后进行SPECT/CT成像。42例患者中，4例在淋巴闪烁显像和SPECT/CT图像上显示出沿胸导管走行的早期淋巴引流。其中1例患者未观察到任何腹膜后淋巴结的介入。在SPECT成像显示有前哨淋巴结的患者中，这种引流模式的频率为（4/22）18.2%。
使用淋巴闪烁显像和SPECT/CT等功能成像方式对肾肿瘤进行前哨淋巴结定位，能够识别和采集常规解剖区域外的前哨淋巴结。如本研究所示，可在活体中观察到通过胸导管的直接异常引流。这可能支持了关于某些解剖学转移部位的假说，以及肾细胞癌腹膜后淋巴结清扫未能显示出生存获益的原因。
