MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede 7500 AE, The Netherlands ; Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands.
Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands.
EJNMMI Res. 2014 May 3;4:19. doi: 10.1186/s13550-014-0019-5. eCollection 2014.
This study was designed to explore the feasibility of replacing the conventional peri-/intratumoural ultrasound (US)-guided technetium-99m albumin nanocolloid ((99m)Tc-nanocolloid) administration by an injection of the same tracer guided by a freehand single-photon emission computed tomography (SPECT) device in patients with non-palpable breast cancer with an iodine-125 ((125)I) seed as tumour marker, who are scheduled for a sentinel lymph node biopsy (SLNB). This approach aimed to decrease the workload of the radiology department, avoiding a second US-guided procedure.
In ten patients, the implanted (125)I seed was primarily localised using freehand SPECT and subsequently verified by conventional US in order to inject the (99m)Tc-nanocolloid. The following 34 patients were injected using only freehand SPECT localisation. In these patients, additional SPECT/CT was acquired to measure the distance between the (99m)Tc-nanocolloid injection depot and the (125)I seed. In retrospect, a group of 21 patients with US-guided (99m)Tc-nanocolloid administrations was included as a control group.
The depth difference measured by US and freehand SPECT in ten patients was 1.6 ± 1.6 mm. In the following 36 (125)I seeds (34 patients), the average difference between the (125)I seed and the centre of the (99m)Tc-nanocolloid injection depot was 10.9 ± 6.8 mm. In the retrospective study, the average distance between the (125)I seed and the centre of the (99m)Tc-nanocolloid injection depot as measured in SPECT/CT was 9.7 ± 6.5 mm and was not significantly different compared to the freehand SPECT-guided group (two-sample Student's t test, p = 0.52).
We conclude that using freehand SPECT for (99m)Tc-nanocolloid administration in patients with non-palpable breast cancer with previously implanted (125)I seed is feasible. This technique may improve daily clinical logistics, reducing the workload of the radiology department.
本研究旨在探讨在计划行前哨淋巴结活检（SLNB）的触诊阴性乳腺癌患者中，是否可以用徒手单光子发射计算机断层扫描（SPECT）设备引导的与常规经皮/瘤内超声（US）引导的锝-99m 白蛋白纳米胶体（99mTc-纳米胶体）注射相同的示踪剂注射来代替，该方法旨在减少放射科的工作量，避免进行第二次 US 引导的操作。
在 10 例患者中，使用徒手 SPECT 初步定位植入的碘-125（125）I 种子，然后用常规 US 进行验证，以便注射 99mTc-纳米胶体。随后，对另外 34 例患者仅使用徒手 SPECT 定位进行注射。在这些患者中，采集额外的 SPECT/CT 以测量 99mTc-纳米胶体注射部位与 125I 种子之间的距离。回顾性地，纳入了一组 21 例经 US 引导的 99mTc-纳米胶体给药的患者作为对照组。
10 例患者 US 和徒手 SPECT 测量的深度差值为 1.6±1.6mm。在随后的 36 个（125）I 种子（34 例患者）中，125I 种子与 99mTc-纳米胶体注射部位中心之间的平均差值为 10.9±6.8mm。在回顾性研究中，SPECT/CT 测量的 125I 种子与 99mTc-纳米胶体注射部位中心之间的平均距离为 9.7±6.5mm，与徒手 SPECT 引导组无显著差异（两样本学生 t 检验，p=0.52）。
我们得出结论，在计划行 SLNB 的触诊阴性乳腺癌患者中，使用徒手 SPECT 进行 99mTc-纳米胶体给药是可行的。该技术可以改善日常临床流程，减少放射科的工作量。
