Fujiwara Masao, Sawada Michifumi, Kasuya Akira, Matsushita Yuki, Yamada Moe, Fukamizu Hidekazu, Magata Yasuhiro, Tokura Yoshiki, Sakahara Harumi
Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Dermatol. 2014 Jun;41(6):498-504. doi: 10.1111/1346-8138.12506.
Some recent reports have revealed that the long scintigraphic appearance time (SAT), defined as the time between radionuclide injection and first sentinel lymph node (SLN) visualization in lymphoscintigraphy, is a negative predictive parameter of nodal metastasis in patients with melanoma. However, most of the methods used to measure the SAT were ambiguous because they utilized visualization in lymphoscintigraphy. We herein introduce a novel method by which to measure the SAT and lymphatic flow rate. The data of 33 patients with primary skin cancer were used. Sequential images were obtained using dynamic lymphoscintigraphy, and a time-activity curve of the SLN was created. The time at which the counts reached plateau was newly defined as an alternative to the SAT and was termed the scintigraphic saturation time (SST). The figure obtained by division of the distance by the SST was newly defined as an alternative to the lymphatic flow rate and termed the lymphatic transit rate (LTR). The SST was clearly determined. It ranged from 220 to 1430 s (mean, 805 s). Pathological examination revealed nodal metastasis in five patients. In 28 patients without metastasis, the mean LTR was in the order of lower limbs (4.07 ± 0.35 cm/min), upper limbs (2.67 ± 0.33 cm/min), trunk (1.79 ± 0.47 cm/min), and head and neck (1.11 ± 0.22 cm/min). The LTRs were higher in patients with nodal metastasis than those without. This method may be effective for accurate measurement of the SAT and lymphatic flow rate.
最近的一些报告显示，长闪烁显像出现时间（SAT），定义为淋巴闪烁显像中放射性核素注射与首个前哨淋巴结（SLN）显影之间的时间，是黑色素瘤患者淋巴结转移的负性预测参数。然而，大多数用于测量SAT的方法并不明确，因为它们利用的是淋巴闪烁显像中的显影情况。我们在此介绍一种测量SAT和淋巴流速的新方法。使用了33例原发性皮肤癌患者的数据。通过动态淋巴闪烁显像获得序列图像，并创建SLN的时间-活性曲线。将计数达到平台期的时间重新定义为SAT的替代指标，并称为闪烁显像饱和时间（SST）。将距离除以SST得到的数值重新定义为淋巴流速的替代指标，并称为淋巴转运速率（LTR）。SST能够清晰确定。其范围为220至1430秒（平均805秒）。病理检查发现5例患者有淋巴结转移。在28例无转移的患者中，平均LTR按下肢（4.07±0.35厘米/分钟）、上肢（2.67±0.33厘米/分钟）、躯干（1.79±0.47厘米/分钟）和头颈部（1.11±0.22厘米/分钟）的顺序依次降低。有淋巴结转移患者的LTR高于无转移患者。该方法可能对准确测量SAT和淋巴流速有效。
