Hoogendam Jacob P, Veldhuis Wouter B, Hobbelink Monique G G, Verheijen René H M, van den Bosch Maurice A A J, Zweemer Ronald P
Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; and
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
J Nucl Med. 2015 May;56(5):675-80. doi: 10.2967/jnumed.114.152439. Epub 2015 Apr 9.
We aimed to compare SPECT/CT and lymphoscintigraphy on overall and bilateral sentinel lymph node (SLN) detection in cervical cancer patients.
A systematic search was performed on August 1, 2014, in PubMed, Embase, Scopus, and the Cochrane library. The syntax was based on synonyms of the terms cervical cancer, SPECT/CT, and lymphoscintigraphy. Retrieved articles were screened on their title/abstract and considered eligible when an SLN procedure was performed using both imaging modalities and if detection results were reported. Two independent reviewers assessed all included studies on methodologic quality using QUADAS-2. Studies were pooled on their odds ratios (ORs) with a random-effects model.
The search yielded 962 unique articles, of which 8 were ultimately included. The studies were recent retrospective or prospective cohort studies of limited size (n = 7-51) but sufficient methodologic quality. The median overall detection (≥1 SLN in a patient) was 98.6% for SPECT/CT (range, 92.2%-100.0%) and 85.3% for lymphoscintigraphy (range, 70.0%-100.0%). This corresponded to a pooled overall SLN detection OR of 2.5 (95% CI, 1.2-5.3) in favor of SPECT/CT. The reported median bilateral detection (≥1 SLN in each hemipelvis) was 69.0% for SPECT/CT (range, 62.7%-79.3%) and 66.7% for lymphoscintigraphy (range, 56.9%-75.8%), yielding a pooled OR of 1.2 (95% CI, 0.7-2.1). No significant difference in the number of visualized SLNs was observed at a pooled ratio of 1.2 (95% CI, 0.9-1.6).
In cervical cancer patients, preoperative SLN imaging with SPECT/CT results in superior overall SLN detection in comparison with planar lymphoscintigraphy.
我们旨在比较SPECT/CT和淋巴闪烁造影在宫颈癌患者中对前哨淋巴结（SLN）的整体及双侧检测情况。
于2014年8月1日在PubMed、Embase、Scopus和Cochrane图书馆进行系统检索。检索语法基于宫颈癌、SPECT/CT和淋巴闪烁造影等术语的同义词。检索到的文章根据标题/摘要进行筛选，当使用两种成像方式进行SLN检查且报告了检测结果时，视为符合条件。两名独立评审员使用QUADAS-2评估所有纳入研究的方法学质量。采用随机效应模型对研究的比值比（OR）进行汇总。
检索共得到962篇独特文章，最终纳入8篇。这些研究为近期的回顾性或前瞻性队列研究，规模有限（n = 7 - 51），但方法学质量足够。SPECT/CT的整体检测中位数（患者中≥1个SLN）为98.6%（范围92.2% - 100.0%），淋巴闪烁造影为85.3%（范围70.0% - 100.0%）。这相当于汇总的整体SLN检测OR为2.5（95%CI，1.2 - 5.3），支持SPECT/CT。报告的双侧检测中位数（每个半盆腔≥1个SLN），SPECT/CT为69.0%（范围62.7% - 79.3%），淋巴闪烁造影为66.7%（范围56.9% - 75.8%），汇总OR为1.2（95%CI，0.7 - 2.1）。在汇总比值比为1.2（95%CI，0.9 - 1.6）时，未观察到可视化SLN数量的显著差异。
在宫颈癌患者中，与平面淋巴闪烁造影相比，术前使用SPECT/CT进行SLN成像可实现更好的整体SLN检测。
