From the *Department of Nuclear Medicine and Endocrinology, Linz General Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria; †Department of Dermatology, Linz General Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria; ‡2nd Surgical Department, Linz General Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria; §Department of Oral and Maxillofacial Surgery, Linz General Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria; ∥Department of Radiology, University of Southern California, Los Angeles, CA; ¶Nuclear Medicine & PET/CT Centre, Santa Maria della Misericordia Hospital, Rovigo, Italy; and **University Clinic of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Clin Nucl Med. 2015 Sep;40(9):e436-40. doi: 10.1097/RLU.0000000000000882.
Patients with invasive malignant melanoma are commonly referred for sentinel lymph node (SLN) detection. A recently proposed 3D tomographic imaging modality is freehand SPECT (declipseSPECT). This "bedside system" was originally developed to enable minimal-invasive image-guided surgery. The aim of this retrospective analysis was to assess the clinical use of this freehand detector device for image-guided lymphatic mapping in melanoma patients.
Thirty-nine patients (12 female and 27 male subjects) were included (age, 30-79 years). All of them had at least one location of melanoma with tumoral stage pT1b or greater in 37 and pTx in 2 patients in different sites of the body (abdomen in 4, back in 14, head and neck in 5, lower extremity in 6, and upper extremity in 10 patients). Lymphoscintigraphy was performed with 65 to 127 MBq Tc-nanocolloid. A 2-day protocol was applied with SPECT-CT acquisition (Brightview XCT, Philips) at day 1 and surgery using radio-guided freehand SPECT at day 2. SPECT-CT data were integrated into the 3D navigation system to enable fast and direct localization of the SLN by displaying the depth of the node from the skin surface and lateral margins in relation to the gamma probe.
Comparable preoperative imaging and intraoperative localization was observed in 18 patients. In 14 cases, more lymph nodes were resected than detected by SPECT-CT including 1 patient without evidence of an SLN because this node was located close to the primary right ear tumor. In 10 of these patients, intraoperative freehand SPECT revealed additional sites of lymph nodes. In 7 cases, more findings were detected by SPECT-CT than surgically removed. The procedure was safe and easy to perform, and the time of surgical intervention using freehand SPECT was in the range of 36 to 133 minutes (mean time, 66.56 minutes).
Freehand SPECT detected more SLN compared with SPECT-CT, and the tracking system provided precise anatomical localization of the radioactive-labeled SLNs.
患有侵袭性恶性黑色素瘤的患者通常需要进行前哨淋巴结 (SLN) 检测。最近提出的一种三维断层成像方式是徒手 SPECT（declipseSPECT）。这种“床边系统”最初是为了实现微创图像引导手术而开发的。本回顾性分析的目的是评估这种徒手探测器设备在黑色素瘤患者图像引导淋巴定位中的临床应用。
共纳入 39 例患者（12 例女性和 27 例男性；年龄 30-79 岁）。他们均至少有一处黑色素瘤病灶，37 例处于肿瘤分期 pT1b 或更高，2 例处于 pTx 分期（4 例位于腹部，14 例位于背部，5 例位于头颈部，6 例位于下肢，10 例位于上肢）。使用 65 至 127MBq Tc-纳米胶体进行淋巴闪烁显像。采用 2 天方案，第 1 天进行 SPECT-CT 采集（Brightview XCT，Philips），第 2 天进行放射性引导徒手 SPECT 手术。将 SPECT-CT 数据集成到 3D 导航系统中，通过显示节点距皮肤表面的深度和相对于伽马探头的外侧边缘，实现 SLN 的快速直接定位。
18 例患者术前成像和术中定位结果相似。14 例患者切除的淋巴结多于 SPECT-CT 检测到的淋巴结，包括 1 例患者因右侧耳部原发性肿瘤附近的 SLN 无法切除而未发现 SLN。在这些患者中的 10 例，术中徒手 SPECT 发现了其他部位的淋巴结。7 例患者 SPECT-CT 检测到的淋巴结比手术切除的多。该程序安全且易于实施，使用徒手 SPECT 的手术干预时间为 36 至 133 分钟（平均时间为 66.56 分钟）。
与 SPECT-CT 相比，徒手 SPECT 检测到更多的 SLN，并且跟踪系统提供了放射性标记 SLN 的精确解剖定位。
