*Department of Obstetrics and Gynecology, †Institute of Biometry, ‡Institute of Pathology, and §Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
Int J Gynecol Cancer. 2014 Feb;24(2):295-302. doi: 10.1097/IGC.0000000000000032.
Precise detection of sentinel lymph nodes (SLNs) seems to be a crucial factor for optimized treatment of cervical cancer. We assess the use of single photon emission computed tomography combined with computed tomography (SPECT/CT) as an alternative to lymphoscintigraphy (LSG) for preoperative identification of SLN.
This study was performed in a prospective, unicentric setting. Patients with cervical carcinoma were scheduled for surgery and additional SLN labeling by peritumoral injection of 10 MBq technetium-99m-nanocolloid and patent blue. Thirty minutes after injection, LSG and SPECT/CT were carried out. We evaluated the number of SLNs detected intraoperatively in LSG and SPECT/CT and the histologic findings of SLN and non-SLN. Subsequently, we determined the impact of these results on the therapeutic approach.
This represents the largest study about SPECT/CT for SLN detection in cervical cancer so far. Between August 2008 and March 2013, 59 cervical cancer patients underwent intraoperative SLN detection. In addition, 51 of these patients underwent preoperative LSG and SPECT/CT. Imaging with SPECT/CT detected singular SLN at significantly higher rate (47/51, 92.2%) than that with planar LSG (43/51, 84.3%, P = 0.044). Furthermore, SPECT/CT performed better than LSG regarding the total number of detected SLN (SPECT/CT median, 3 [0-18]; LSG median, 2 [0-15]) and detection rates per pelvic side (SPECT/CT 76.9%, LSG 69.2%, P < 0.01). Whenever SLN detection succeeded, histologic evaluation of SLN correctly predicted the lymph node status per patient's side. Using this type of diagnostic approach for lymph node staging, we reached sensitivity of 100% and negative predictive value of 100% at a rate of false-negative results of 0% even in tumors larger than 4 cm.
Single photon emission computed tomography combined with computed tomography imaging leads to improved rates of SLN detection and better anatomic correlation compared with planar LSG. Thus, intraoperative detection of SLN can be improved by preoperative SPECT/CT imaging. This enhances the clinical value of SLN technique and improves the oncologic safety of SLN concept.
准确检测前哨淋巴结（SLN）似乎是优化宫颈癌治疗的关键因素。我们评估单光子发射计算机断层扫描（SPECT）联合计算机断层扫描（CT）在术前识别 SLN 方面作为淋巴闪烁显像（LSG）的替代方法的应用。
本研究为前瞻性单中心研究。宫颈癌患者接受手术，并通过肿瘤周围注射 10MBq 锝-99m-纳米胶体和专利蓝进行额外的 SLN 标记。注射后 30 分钟进行 LSG 和 SPECT/CT。我们评估了术中 LSG 和 SPECT/CT 检测到的 SLN 数量以及 SLN 和非 SLN 的组织学发现。随后，我们确定了这些结果对治疗方法的影响。
这是迄今为止关于 SPECT/CT 在宫颈癌 SLN 检测中应用的最大研究。2008 年 8 月至 2013 年 3 月，59 例宫颈癌患者接受了术中 SLN 检测。此外，其中 51 例患者在术前接受了 LSG 和 SPECT/CT。SPECT/CT 成像检测到单个 SLN 的比例明显高于平面 LSG（47/51，92.2% vs. 43/51，84.3%，P=0.044）。此外，SPECT/CT 在检测到的 SLN 总数（SPECT/CT 中位数 3[0-18]；LSG 中位数 2[0-15]）和每个骨盆侧的检测率（SPECT/CT 76.9%，LSG 69.2%，P<0.01）方面优于 LSG。只要 SLN 检测成功，每个患者侧的 SLN 组织学评估正确预测了淋巴结状态。使用这种类型的淋巴结分期诊断方法，我们达到了 100%的敏感性和 100%的阴性预测值，假阴性率为 0%，即使肿瘤大于 4cm。
与平面 LSG 相比，SPECT/CT 成像导致 SLN 检测率提高和更好的解剖相关性。因此，术前 SPECT/CT 成像可以改善术中 SLN 的检测。这提高了 SLN 技术的临床价值，并提高了 SLN 概念的肿瘤学安全性。
