Nuclear Medicine Department, Hospital Clínic, Villarroel, 170 08036, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Eur J Nucl Med Mol Imaging. 2017 Oct;44(11):1853-1861. doi: 10.1007/s00259-017-3706-4. Epub 2017 May 10.
Sentinel lymph node biopsy (SLNB) can be used for nodal staging in early cervical cancer. For this purpose, the tracers most commonly used are radiotracers based on technetium. For the last decade, indocyanine green (ICG) has been used as a tracer for SLNB in other malignancies with excellent results and, more recently, a combination of ICG and a radiotracer has been shown to have the advantages of both tracers. The aim of this study was to evaluate the role of ICG-Tc-nanocolloid in SLN detection in patients with cervical cancer.
This prospective study included 16 patients with cervical cancer. The hybrid tracer was injected the day (19-21 h) before surgery for planar and SPECT/CT lymphoscintigraphy. Blue dye was administered periorificially in 14 patients. SLNs were removed according to their distribution on lymphoscintigraphy and when radioactive, fluorescent and/or stained with blue dye. Nodal specimens were pathologically analysed for metastases including by immunochemistry.
Lymphoscintigraphy and SPECT/CT showed drainage in all patients. A total of 69 SLNs were removed, of which 66 were detected by their radioactivity signal and 67 by their fluorescence signal. Blue dye identified only 35 SLNs in 12 of the 14 patients (85.7%). All patients showed bilateral pelvic drainage. Micrometastases were diagnosed in two patients, and were the only lymphatic nodes involved.
SLNB with ICG-Tc-nanocolloid is feasible and safe in patients with early cervical cancer. This hybrid tracer provided bilateral SLN detection in all patients and a higher detection rate than blue dye, so it could become an alternative to the combined technique.
前哨淋巴结活检 (SLNB) 可用于早期宫颈癌的淋巴结分期。为此，最常使用的示踪剂是基于锝的放射性示踪剂。在过去的十年中，吲哚菁绿 (ICG) 已被用于其他恶性肿瘤的 SLNB 示踪剂，取得了优异的效果，最近，ICG 与放射性示踪剂的联合使用显示出了两种示踪剂的优势。本研究旨在评估 ICG-Tc-纳米胶体在宫颈癌患者 SLN 检测中的作用。
这是一项前瞻性研究，纳入了 16 例宫颈癌患者。在手术前一天（19-21 小时）注射混合示踪剂，进行平面和 SPECT/CT 淋巴闪烁显像。在 14 例患者中经口周注射蓝色染料。根据淋巴闪烁显像和放射性、荧光和/或蓝色染料染色的分布取出前哨淋巴结。对淋巴结标本进行病理分析，包括免疫化学分析，以确定是否存在转移。
淋巴闪烁显像和 SPECT/CT 显示所有患者均有引流。共取出 69 枚前哨淋巴结，其中 66 枚通过放射性信号检测到，67 枚通过荧光信号检测到。在 14 例患者中的 12 例（85.7%）中，蓝色染料仅识别出 35 枚前哨淋巴结。所有患者均显示双侧盆腔引流。两名患者诊断出微转移，且为唯一受累的淋巴结。
ICG-Tc-纳米胶体的 SLNB 在早期宫颈癌患者中是可行且安全的。这种混合示踪剂可在所有患者中提供双侧 SLN 检测，并且比蓝色染料具有更高的检测率，因此可能成为联合技术的替代方法。
