Naumann Carsten Maik, Colberg Christian, Jüptner Michael, Marx Marlies, Zhao Yi, Jiang Ping, Hamann Moritz Franz, Jünemann Klaus-Peter, Zuhayra Maaz, Lützen Ulf
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany.
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Kiel, Germany.
Urol Oncol. 2018 Mar;36(3):92.e17-92.e24. doi: 10.1016/j.urolonc.2017.11.012. Epub 2017 Dec 14.
Sentinel lymph node (SLN) biopsy represents a well-established diagnostic tool for the assessment of lymphatic metastasis. Correct pre- and intraoperative visualization of SLN is of the utmost importance to ensure the safety and feasibility of the procedure. Aim of this study was to evaluate the diagnostic value of preoperative SLN imaging via single photon emission computed tomography/computed tomography (SPECT/CT) and planar scintigraphy in patients with penile carcinoma with nonpalpable inguinal lymph nodes.
After peritumoral intradermal tracer injection (150MBq/4.05mCi Tc-99m nanocolloid), we acquired planar scintigraphies including indirect body contouring using a twin head gamma camera. Subsequently we acquired SPECT/CT images of the abdomen via a hybrid system. Prospective evaluation of 52 groins in 26 examined patients was done for all image files obtained with both techniques by 2 trained experts in consensual assessment.
A total of 71 SLNs in 37 groins were identified by means of planar scintigraphy. In these images, no radiolabeled lymph nodes were visualized in 15 out of 52 groins (28.8%). The SPECT/CT images showed a total of 82 SLNs in 42 groins. In 19.2% (10 of the 52 groins), there was no visualization of lymph nodes in SPECT/CT. 8 SLNs in 7 groins that were visualized in the planar technique were found to be false positive by SPECT/CT. In total, 19 SLNs in 16 groins that were overlooked by planar imaging could only be detected by SPECT/CT. In contrast to planar scintigraphy, SPECT/CT imaging enabled clear and precise anatomical localization of SLNs in all 42 groins where radiolabeled SLNs were visible. Even under consideration of all lymphatic drainage regions, statistical evaluation showed a significantly higher number of detected SLNs with SPECT/CT in comparison to the planar technique (P = 0.0022).
In these patients SPECT/CT is capable of visualizing SLNs that cannot be detected with planar imaging. The SPECT/CT technique reduces the number of false positive findings from planar SLN imaging and is able to show anatomic SLN localization more precisely. If possible, preoperative SLN imaging should be performed by means of the SPECT/CT technique in patients with this tumor entity.
前哨淋巴结（SLN）活检是评估淋巴转移的一种成熟诊断工具。前哨淋巴结术前和术中的正确显像是确保该手术安全性和可行性的至关重要因素。本研究的目的是评估术前通过单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）和平面闪烁扫描对阴茎癌且腹股沟淋巴结不可触及患者前哨淋巴结成像的诊断价值。
在肿瘤周围皮内注射示踪剂（150MBq/4.05mCi锝-99m纳米胶体）后，我们使用双头γ相机采集平面闪烁扫描图像，包括间接身体轮廓成像。随后，通过混合系统采集腹部的SPECT/CT图像。两名经过培训的专家对通过这两种技术获得的所有图像文件进行前瞻性评估，对26例接受检查患者的52个腹股沟进行一致性评估。
通过平面闪烁扫描在37个腹股沟中总共识别出71个前哨淋巴结。在这些图像中，52个腹股沟中有15个（28.8%）未发现放射性标记的淋巴结。SPECT/CT图像在42个腹股沟中总共显示了82个前哨淋巴结。在SPECT/CT中，52个腹股沟中有10个（19.2%）未发现淋巴结显影。平面技术显示的7个腹股沟中的8个前哨淋巴结被SPECT/CT发现为假阳性。总共有16个腹股沟中的19个前哨淋巴结被平面成像遗漏，只能通过SPECT/CT检测到。与平面闪烁扫描不同，SPECT/CT成像能够在所有42个可见放射性标记前哨淋巴结的腹股沟中清晰、精确地对前哨淋巴结进行解剖定位。即使考虑所有淋巴引流区域，统计评估显示，与平面技术相比，SPECT/CT检测到的前哨淋巴结数量显著更多（P = 0.0022）。
在这些患者中，SPECT/CT能够显示平面成像无法检测到的前哨淋巴结。SPECT/CT技术减少了平面前哨淋巴结成像的假阳性结果数量，并且能够更精确地显示前哨淋巴结的解剖定位。如果可能，对于患有这种肿瘤实体的患者，术前前哨淋巴结成像应采用SPECT/CT技术进行。
