Collarino Angela, Donswijk Maarten L, van Driel Willemien J, Stokkel Marcel P, Valdés Olmos Renato A
Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168, Rome, Italy.
Eur J Nucl Med Mol Imaging. 2015 Dec;42(13):2064-71. doi: 10.1007/s00259-015-3127-1. Epub 2015 Jul 30.
To determine the lymphatic drainage pattern using SPECT/CT in clinically node-negative (cN0) patients with vulvar cancer, and to evaluate the possible implications for the extent of inguinal lymph node dissection.
A total of 83 patients with vulvar cancer scheduled for sentinel node (SN) biopsy were injected peritumorally with radioactive nanocolloid particles followed by lymphoscintigraphy and SPECT/CT for anatomical localization. The SN and higher-echelon nodes on SPECT/CT were located in different zones in the groin and pelvic region. The groin was divided into five zones according to Daseler et al.: four zones obtained by drawing two perpendicular lines over the saphenofemoral junction and one zone directly overlying this junction. The nodes in the pelvic region were classified into three zones: external iliac/obturator, the common iliac and the paraaortic zones.
A total of 217 SNs and 202 higher-echelon nodes were localized on SPECT/CT. All SNs were located in the five zones according to Daseler et al.: 149 (69%) in the medial superior region, 31 (14%) in the medial inferior region, 22 (10%) in the central region, 14 (6.5%) in the lateral superior region and only 1 (0.5%) in the lateral inferior region. The higher-echelon nodes were located both in the groin (15%) and in the pelvic region (85%).
In patients with cN0 vulvar cancer, lymphatic drainage occurs predominantly to the medial regions of the groin. Drainage to the lateral inferior region of the groin is only incidental and in SN-positive patients this zone might be spared in subsequent extended lymph node dissection. This may lead to a decrease in the morbidity associated with this procedure. SPECT/CT is able to personalize lymphatic mapping, providing detailed information about the number and anatomical location of SNs for adequate surgical planning in the groin.
利用单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）确定临床淋巴结阴性（cN0）的外阴癌患者的淋巴引流模式，并评估其对腹股沟淋巴结清扫范围的可能影响。
共有83例计划进行前哨淋巴结（SN）活检的外阴癌患者在肿瘤周围注射放射性纳米胶体颗粒，随后进行淋巴闪烁显像和SPECT/CT以进行解剖定位。SPECT/CT上的SN和更高一级淋巴结位于腹股沟和盆腔区域的不同区域。根据达塞勒等人的方法，将腹股沟分为五个区域：通过在股隐静脉交界处上方画两条垂直线得到四个区域，以及直接位于该交界处上方的一个区域。盆腔区域的淋巴结分为三个区域：髂外/闭孔、髂总及腹主动脉旁区域。
SPECT/CT上共定位了217个SN和202个更高一级淋巴结。根据达塞勒等人的方法，所有SN均位于五个区域：149个（69%）位于上内侧区域，31个（14%）位于下内侧区域，22个（10%）位于中央区域，14个（6.5%）位于上外侧区域，仅1个（0.5%）位于下外侧区域。更高一级淋巴结位于腹股沟（15%）和盆腔区域（85%）。
在cN0外阴癌患者中，淋巴引流主要发生在腹股沟的内侧区域。引流至腹股沟下外侧区域只是偶然情况，在SN阳性患者中，该区域在后续扩大淋巴结清扫时可能可以保留。这可能会降低该手术相关的发病率。SPECT/CT能够实现淋巴图谱个体化，为腹股沟的充分手术规划提供有关SN数量和解剖位置的详细信息。
