Valdés Olmos R A, Rietbergen D D, Vidal-Sicart S, Manca G, Giammarile F, Mariani G
Diagnostic Oncology, Nuclear Medicine Department Netherlands Cancer Institute Antoni van Leewenhoek Hospital Amsterdam, The Netherlands -
Q J Nucl Med Mol Imaging. 2014 Jun;58(2):127-39.
A few years ago SPECT/CT was successfully incorporated into the sentinel node (SN) procedure for breast cancer and melanoma. Important contributions of SPECT/CT in these two malignancies were the anatomical localization of SNs already visualized on planar images, the detection of additional SNs in aberrant basins, and the depiction of SNs in cases with no visualization on planar images. Recently, in a large series of melanoma patients the use of SPECT/CT was associated with the detection of more metastatic SNs and a higher rate of disease-free survival. Following the experiences in breast cancer and melanoma, SPECT/CT has been applied in oral cavity cancer as well as in urological and gynaecological malignancies. In the areas of lymphatic drainage of these malignancies (head and neck, pelvis, and upper abdomen) SPECT/CT appears to be essential to localize SNs, providing surgeons with helpful anatomical landmarks to plan SN biopsies. In gastrointestinal and lung malignancies SPECT/CT has only incidentally been used. With the improvement of the CT component in the second generation of SPECT/CT gamma cameras, nuclear physicians today can identify lymph nodes corresponding with the radioactive SNs. This is possible using a display of SPECT/CT similar to that of conventional tomography. Multiplanar reconstruction enables to correlate radioactive sentinel nodes seen on fused SPECT/CT with lymph nodes seen on CT, and the use of cross-reference lines allows the navigation between axial, coronal and sagittal views. This visual information is helpful for the intraoperative procedure and for post-excision assessment using portable devices. Fused SPECT/CT images may also be three-dimensionally displayed, improving anatomical SN localisation and recognition. This recent imaging improvement is leading to a new paradigm of "see and open" in contraposition to the former "open and see" in the SN procedure. The new mixed reality protocols which are able to transfer SPECT/CT to the operating room for surgical navigation will reinforce this "see and open" concept. However, a comprehensive interpretation of SPECT/CT together with lymphoscintigraphy is necessary to identify radioactive lymph nodes as sentinel nodes and classify them into different categories that are important for the intraoperative procedure.
几年前，单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）成功应用于乳腺癌和黑色素瘤的前哨淋巴结（SN）手术。SPECT/CT在这两种恶性肿瘤中的重要贡献包括对平面图像上已显示的SN进行解剖定位、检测异常区域的额外SN以及在平面图像上未显示的情况下描绘SN。最近，在一大系列黑色素瘤患者中，使用SPECT/CT与检测到更多转移性SN和更高的无病生存率相关。继乳腺癌和黑色素瘤的经验之后，SPECT/CT也已应用于口腔癌以及泌尿生殖系统恶性肿瘤。在这些恶性肿瘤的淋巴引流区域（头颈部、骨盆和上腹部），SPECT/CT对于定位SN似乎至关重要，为外科医生提供有助于规划SN活检的解剖标志。在胃肠道和肺部恶性肿瘤中，SPECT/CT仅偶尔使用。随着第二代SPECT/CT伽马相机中CT组件的改进，核医学医生如今能够识别与放射性SN相对应的淋巴结。这可以通过使用类似于传统断层扫描的SPECT/CT显示来实现。多平面重建能够将融合的SPECT/CT上看到的放射性前哨淋巴结与CT上看到的淋巴结相关联，并且使用交叉参考线允许在轴向、冠状和矢状视图之间导航。这种视觉信息有助于术中操作以及使用便携式设备进行切除后评估。融合的SPECT/CT图像也可以三维显示，改善SN的解剖定位和识别。这种最新的成像改进正在导致与之前SN手术中的“切开再看”相对的“先看再切开”的新范式。能够将SPECT/CT传输到手术室用于手术导航的新的混合现实协议将强化这种“先看再切开”的概念。然而，必须将SPECT/CT与淋巴闪烁造影术进行综合解读，以将放射性淋巴结识别为前哨淋巴结并将它们分类为对术中操作很重要的不同类别。
