Centre Hospitalier de Bastia, Bastia, France
Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.
Int J Gynecol Cancer. 2021 May;31(5):679-685. doi: 10.1136/ijgc-2020-002198. Epub 2021 Mar 1.
The objective was to evaluate whether hybrid imaging combining single photon emission tomography with computed tomography (SPECT/CT) provides additional clinical value for dectection of sentinel lymph nodes (SLNs) compared with intraoperative combined mapping in uterine and cervical malignancies.
This was a retrospective study of prospectively collected data from patients with stages IA-IB2 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2018) or stage I endometrial cancer, who underwent preoperative SPECT/CT for SLN detection. All included patients had dual injection of technetium-99m (Tc) with patent blue or indocyanine green.
A total of 171 patients were included with 468 SLNs detected during surgery: 146/171 patients (85.4%) had both radiotracer and blue injection whereas 25/171 patients (14.6%) had radiotracer and indocyanine green injected. The overall detection rate was 95.3%. The detection rate of SLN mapping was 74.9% for SPECT/CT, 90.6% for Tc, 91.8% for blue dye, and 100% for indocyanine green. Bilateral drainage was found in 140 patients (81.9%), detected by Tc in 105 patients (61.4%), by blue in 99 patients (67.3%), by indocyanine green in 23 patients (92%), and by SPECT/CT in 62 patients (36.4%). Atypical SLN locations were identified by SPECT/CT in 64 patients (37.4%), by 99mTc in 28 patients (16.4%), by blue in 17 patients (9.9%), and by indocyanine green in 8 patients (4.7%). Sensitivity and negative predictive value of SLN biopsy to detect lymph node metastasis using dual injection of different intraoperative combined techniques were 88.9% and 97.5%, respectively.
SPECT/CT enhanced topographic delineation of SLN and more accurately identified drainage to atypical locations. Fluorescent SLN mapping using indocyanine green offered the highest SLN detection rate. When indocyanine green was used, SPECT/CT did not increase SLN detection, and did not add further information to improve lymph node localization and removal.
本研究旨在评估单光子发射断层扫描与计算机断层扫描（SPECT/CT）相结合的混合成像是否比子宫和宫颈恶性肿瘤的术中联合定位更能为前哨淋巴结（SLN）检测提供额外的临床价值。
这是一项回顾性研究，对接受术前 SPECT/CT 用于 SLN 检测的国际妇产科联合会（FIGO）2018 分期为 IA-IB2 期宫颈癌或 I 期子宫内膜癌患者的前瞻性采集数据进行了研究。所有纳入的患者均接受了锝-99m（Tc）和专利蓝或吲哚菁绿的双重注射。
共纳入 171 例患者，术中检测到 468 个 SLN：146/171 例（85.4%）同时进行放射性示踪剂和蓝色注射，25/171 例（14.6%）进行放射性示踪剂和吲哚菁绿注射。总体检测率为 95.3%。SPECT/CT 的 SLN 检测率为 74.9%，Tc 为 90.6%，蓝色染料为 91.8%，吲哚菁绿为 100%。140 例患者（81.9%）存在双侧引流，其中 105 例患者（61.4%）通过 Tc 检测到，99 例患者（67.3%）通过蓝色染料检测到，23 例患者（92%）通过吲哚菁绿检测到，62 例患者（36.4%）通过 SPECT/CT 检测到。SPECT/CT 发现 64 例（37.4%）患者存在非典型 SLN 位置，99mTc 发现 28 例（16.4%），蓝色染料发现 17 例（9.9%），吲哚菁绿发现 8 例（4.7%）。使用不同术中联合技术的双注射 SLN 活检检测淋巴结转移的敏感性和阴性预测值分别为 88.9%和 97.5%。
SPECT/CT 增强了 SLN 的解剖描绘，更准确地识别了非典型引流部位。吲哚菁绿荧光 SLN 制图提供了最高的 SLN 检测率。当使用吲哚菁绿时，SPECT/CT 并未增加 SLN 的检测，也没有提供更多信息来改善淋巴结定位和切除。
