Mahieu Rutger, Donders Dominique N V, Dankbaar Jan Willem, de Bree Remco, de Keizer Bart
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
J Clin Med. 2022 Aug 31;11(17):5129. doi: 10.3390/jcm11175129.
This study evaluated sentinel lymph node (SLN) identification with CT lymphography (CTL) following peritumoral administration of Lipiodol relative to conventional Tc-nanocolloid lymphoscintigraphy (including SPECT/CT) in 10 early-stage oral cancer patients undergoing SLN biopsy. Patients first underwent early dynamic and static scintigraphy after peritumoral administration of Tc-nanocolloid. Subsequently, Lipiodol was administered at the same injection sites, followed by fluoroscopy and CT acquisition. Finally, late scintigraphy and SPECT/CT were conducted, enabling the fusion of late CTL and SPECT imaging. The next day, designated SLNs were harvested, radiographically examined for Lipiodol uptake and histopathologically assessed. Corresponding images of CT, Tc-nanocolloid lymphoscintigraphy and SPECT/late CTL fusion were evaluated. Tc-nanocolloid lymphoscintigraphy identified 21 SLNs, of which 7 were identified with CTL (33%). CTL identified no additional SLNs and failed to identify any SLNs in four patients (40%). Out of six histopathologically positive SLNs, two were identified by CTL (33%). Radiographic examination confirmed Lipiodol uptake in seven harvested SLNs (24%), of which five were depicted by CTL. CTL using Lipiodol reached a sensitivity of 50% and a negative predictive value (NPV) of 75% (median follow-up: 12.3 months). These results suggest that CTL using Lipiodol is not a reliable technique for SLN mapping in early-stage oral cancer.
本研究评估了在10例接受前哨淋巴结（SLN）活检的早期口腔癌患者中，相对于传统的锝纳米胶体淋巴闪烁显像（包括SPECT/CT），在瘤周注射碘油后用CT淋巴造影（CTL）识别前哨淋巴结的情况。患者在瘤周注射锝纳米胶体后首先进行早期动态和静态闪烁显像。随后，在相同注射部位注射碘油，接着进行透视和CT采集。最后，进行延迟闪烁显像和SPECT/CT，实现延迟CTL和SPECT图像融合。第二天，获取指定的前哨淋巴结，进行影像学检查以评估碘油摄取情况，并进行组织病理学评估。对CT、锝纳米胶体淋巴闪烁显像和SPECT/延迟CTL融合的相应图像进行评估。锝纳米胶体淋巴闪烁显像识别出21个前哨淋巴结，其中7个可通过CTL识别（33%）。CTL未识别出额外的前哨淋巴结，且在4例患者（40%）中未能识别出任何前哨淋巴结。在6个组织病理学阳性的前哨淋巴结中，2个可通过CTL识别（33%）。影像学检查证实7个获取的前哨淋巴结（24%）中有碘油摄取，其中5个由CTL显示。使用碘油的CTL敏感性达到50%，阴性预测值（NPV）为75%（中位随访时间：12.3个月）。这些结果表明，在早期口腔癌中，使用碘油的CTL并非一种可靠的前哨淋巴结定位技术。
