Chandra Piyush, Dhake Sanket, Shah Sneha, Agrawal Archi, Purandare Nilendu, Rangarajan Venkatesh
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai, India.
Indian J Nucl Med. 2017 Apr-Jun;32(2):98-102. doi: 10.4103/0972-3919.202244.
Evidence supporting the use of Sentinel node biopsy (SNB) for nodal staging of early oral squamous cell carcinomas (OSCC) appears to be very promising. Pre-operative lymphatic mapping using planar lymphoscinitigraphy (PL) with or without SPECT/CT in the SNB procedure is useful in sentinel node localization and for planning appropriate surgery. Recently, a large prospective multi-centric study evaluating SNB in cutaneous melanoma, breast and pelvic malignancies, demonstrated that adding SPECT to PL leads to surgical adjustments in a considerable number of patients. Our aim of this study was to evaluate the incremental value of additional SPECT/CT over PL alone in SNB for OSCC.
This was a retrospective analysis of 44 patients (40- tongue, 4- buccal mucosa) with T1-T2, clinically N0 oral cavity SCC who underwent sentinel node biopsy procedure. PL and SPECT lymphoscinitigraphy images were compared for pre-operative mapping of sentinel nodes.
Using a handheld gamma probe, a total of 179 sentinel nodes were harvested, with a mean of 4.06 per patient. PL revealed 75 hotspots with a mean of 1.70 per patient, and SPECT/CT revealed 92 hotspots with a mean of 2.09 per patient. Additional hotpots were identified in 14 patients on SPECT/CT, which included 4 patients, where PL did not detect any sentinel nodes.
Pre-operative SPECT/CT in addition to planar lympho-scinitigraphy in sentinel node biopsies of oral cavity SCC detects more number of sentinel nodes compared to planar imaging alone. The higher sensitivity of SPECT combined with better anatomical localization using diagnostic CT may further improve the precision of SNB procedure.
支持前哨淋巴结活检（SNB）用于早期口腔鳞状细胞癌（OSCC）淋巴结分期的证据似乎非常有前景。在SNB手术中，使用平面淋巴闪烁显像（PL）结合或不结合SPECT/CT进行术前淋巴绘图，有助于前哨淋巴结定位和规划合适的手术。最近，一项评估SNB在皮肤黑色素瘤、乳腺癌和盆腔恶性肿瘤中的大型前瞻性多中心研究表明，在PL基础上增加SPECT可使相当数量的患者进行手术调整。本研究的目的是评估在OSCC的SNB中，额外的SPECT/CT相对于单独的PL的增量价值。
这是一项对44例T1-T2期、临床N0期口腔鳞状细胞癌患者（40例舌癌、4例颊黏膜癌）进行前哨淋巴结活检手术的回顾性分析。比较PL和SPECT淋巴闪烁显像图像用于术前前哨淋巴结绘图。
使用手持γ探针，共采集了179个前哨淋巴结，平均每位患者4.06个。PL显示75个热点，平均每位患者1.70个；SPECT/CT显示92个热点，平均每位患者2.09个。在14例患者的SPECT/CT上发现了额外的热点，其中包括4例PL未检测到任何前哨淋巴结的患者。
在口腔鳞状细胞癌的前哨淋巴结活检中，除平面淋巴闪烁显像外，术前SPECT/CT检测到的前哨淋巴结数量比单独的平面成像更多。SPECT的更高灵敏度与诊断CT更好的解剖定位相结合，可能会进一步提高SNB手术的精确度。
