Sadeghi Ramin, Aliakbarian Mohsen, Shayegani Hamed, Memar Bahram, Dabbagh Vahid Reza
Nuclear Medicine Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Surgical Oncology Research Center, Imam Reza 2 Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Ann Hepatobiliary Pancreat Surg. 2020 Aug 31;24(3):277-282. doi: 10.14701/ahbps.2020.24.3.277.
BACKGROUNDS/AIMS: Pancreaticoduodenectomy is the only potentially curative treatment for pancreatic cancer. The identification of the first nodal drainage site (sentinel node) may improve the detection of metastatic nodes and can contribute to a less invasive surgery. We aimed to determine the accuracy of sentinel node mapping in patients with pancreatic cancer using intraoperative radiotracer injection technique.
At surgical exposure, peritumoral injection of 0.4-0.5 mci/0.5 ml of 99mTc- sodium phytate was performed. After tumor resection, sentinel nodes were investigated in the most common areas using a hand-held gamma probe. Any lymph node with in vivo count twice the background was considered as sentinel node, thus, it was removed and sent for pathological assessment. Then a standard lymph node dissection was performed for all patients.
Fourteen patients with cancer in the head of the pancreas were included in this study. Overall, 180 lymph nodes were harvested with a mean of 11.6±4.7 lymph nodes per patient. In eight patients, at least one sentinel node could be identified (detection rate about 64%). False negative rate of the study was 3/5 (60%).
Our study revealed insufficient diagnostic accuracy and high false negative rate for sentinel lymph node mapping with 99mTc- sodium phytate in pancreatic cancer.
背景/目的：胰十二指肠切除术是胰腺癌唯一可能治愈的治疗方法。识别首个淋巴结引流部位（前哨淋巴结）可能会提高转移性淋巴结的检测率，并有助于减少手术的侵袭性。我们旨在使用术中放射性示踪剂注射技术确定胰腺癌患者前哨淋巴结定位的准确性。
在手术暴露时，在肿瘤周围注射0.4 - 0.5毫居里/0.5毫升的99m锝 - 植酸钠。肿瘤切除后，使用手持式γ探头在最常见的区域探查前哨淋巴结。任何体内计数是背景两倍的淋巴结都被视为前哨淋巴结，因此将其切除并送去进行病理评估。然后对所有患者进行标准的淋巴结清扫。
本研究纳入了14例胰头癌患者。总体而言，共采集了180个淋巴结，每位患者平均采集11.6±4.7个淋巴结。在8例患者中，至少可以识别出1个前哨淋巴结（检测率约为64%）。该研究的假阴性率为3/5（60%）。
我们的研究表明，在胰腺癌中使用99m锝 - 植酸钠进行前哨淋巴结定位的诊断准确性不足且假阴性率高。
