Remenschneider Aaron K, Dilger Amanda E, Wang Yingbing, Palmer Edwin L, Scott James A, Emerick Kevin S
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
Laryngoscope. 2015 Apr;125(4):877-82. doi: 10.1002/lary.25024. Epub 2014 Nov 12.
OBJECTIVES/HYPOTHESIS: Preoperative localization of sentinel lymph nodes in head and neck cutaneous malignancies can be aided by single-photon emission computed tomography/computed tomography (SPECT/CT); however, its true predictive value for identifying lymph nodes intraoperatively remains unquantified. This study aims to understand the sensitivity, specificity, and positive and negative predictive values of SPECT/CT in sentinel lymph node biopsy for cutaneous malignancies of the head and neck.
Blinded retrospective imaging review with comparison to intraoperative gamma probe confirmed sentinel lymph nodes.
A consecutive series of patients with a head and neck cutaneous malignancy underwent preoperative SPECT/CT followed by sentinel lymph node biopsy with a gamma probe. Two nuclear medicine physicians, blinded to clinical data, independently reviewed each SPECT/CT. Activity within radiographically defined nodal basins was recorded and compared to intraoperative gamma probe findings. Sensitivity, specificity, and negative and positive predictive values were calculated with subgroup stratification by primary tumor site.
Ninety-two imaging reads were performed on 47 patients with cutaneous malignancy who underwent SPECT/CT followed by sentinel lymph node biopsy. Overall sensitivity was 73%, specificity 92%, positive predictive value 54%, and negative predictive value 96%. The predictive ability of SPECT/CT to identify the basin or an adjacent basin containing the single hottest node was 92%. SPECT/CT overestimated uptake by an average of one nodal basin. In the head and neck, SPECT/CT has higher reliability for primary lesions of the eyelid, scalp, and cheek.
SPECT/CT has high sensitivity, specificity, and negative predictive value, but may overestimate relevant nodal basins in sentinel lymph node biopsy.
目的/假设：单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）有助于对头颈部皮肤恶性肿瘤前哨淋巴结进行术前定位；然而，其在术中识别淋巴结的真正预测价值仍未得到量化。本研究旨在了解SPECT/CT在头颈部皮肤恶性肿瘤前哨淋巴结活检中的敏感性、特异性、阳性预测值和阴性预测值。
采用盲法回顾性影像评估，并与术中γ探针确认的前哨淋巴结进行比较。
连续纳入一系列头颈部皮肤恶性肿瘤患者，术前行SPECT/CT检查，随后用γ探针进行前哨淋巴结活检。两名对临床资料不知情的核医学医师独立评估每例SPECT/CT。记录影像学定义的淋巴结区域内的活性，并与术中γ探针检查结果进行比较。按原发肿瘤部位进行亚组分层，计算敏感性、特异性、阴性和阳性预测值。
对47例行SPECT/CT检查并随后进行前哨淋巴结活检的皮肤恶性肿瘤患者进行了92次影像解读。总体敏感性为73%，特异性为92%，阳性预测值为54%，阴性预测值为96%。SPECT/CT识别包含单个最热点淋巴结的区域或相邻区域的预测能力为92%。SPECT/CT平均高估一个淋巴结区域的摄取情况。在头颈部，SPECT/CT对眼睑、头皮和脸颊的原发性病变具有更高的可靠性。
SPECT/CT具有较高的敏感性、特异性和阴性预测值，但在前哨淋巴结活检中可能高估相关淋巴结区域。
