Donders Dominique N V, Mahieu Rutger, Tellman Roosmarijn S, Philippens Marielle E P, van Es Robert J J, Van Cann Ellen M, Breimer Gerben E, de Bree Remco, de Keizer Bart
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Department of Radiotherapy, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
J Clin Med. 2024 Nov 22;13(23):7052. doi: 10.3390/jcm13237052.
To assess the efficacy of magnetic resonance (MR) lymphography with gadobutrol contrast for sentinel lymph node (SLN) mapping in early-stage oral squamous cell carcinoma (OSCC). This pilot study compared the identification of SLNs by MR lymphography using a gadolinium-based contrast agent (gadobutrol) to conventional [Tc]Tc-nanocolloid lymphoscintigraphy (including single-photon emission computed tomography/computed tomography (SPECT/CT)) in 10 early-stage OSCC patients undergoing SLN biopsy. The patients initially underwent conventional lymphoscintigraphy following the peritumoral administration of indocyanine green [Tc]Tc-nanocolloid (120 megabecquerel; ~0.5 mL). Subsequently, 0.5-1.0 mL gadobutrol was peritumorally injected, and MR imaging was acquired for 30 min. The following day, the identified SLNs were harvested and subjected to a histopathological assessment. The MR lymphography and [Tc]Tc-nanocolloid lymphoscintigraphy results were evaluated and compared with respect to those of the SLN identification. The reference standard consisted of a histopathological evaluation of the harvested SLNs, complementary neck dissection specimens, and follow-up data. The MR lymphography detected 16 out of 27 SLNs identified by [Tc]Tc-nanocolloid lymphoscintigraphy, revealing an additional SLN that did not harbor metastasis. MR lymphography failed to identify any SLNs in one patient. Of the seven histopathologically positive SLNs detected by [Tc]Tc-nanocolloid lymphoscintigraphy, three were identified by MR lymphography. All patients remained disease-free after a median follow-up of 16 months. Compared to [Tc]Tc-nanocolloid lymphoscintigraphy, MR lymphography using gadobutrol achieved an SLN identification rate of 59%, a sensitivity of 75%, and a negative predictive value of 86%. MR lymphography using gadobutrol demonstrates limited reliability for SLN mapping in early-stage OSCC.
评估钆布醇对比剂磁共振（MR）淋巴造影在早期口腔鳞状细胞癌（OSCC）前哨淋巴结（SLN）定位中的有效性。这项前瞻性研究比较了10例接受SLN活检的早期OSCC患者中，使用钆基对比剂（钆布醇）的MR淋巴造影与传统的[锝]Tc-纳米胶体淋巴闪烁显像（包括单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT））对SLN的识别情况。患者最初在瘤周注射吲哚菁绿[锝]Tc-纳米胶体（120兆贝克勒尔；约0.5毫升）后接受传统淋巴闪烁显像。随后，瘤周注射0.5 - 1.0毫升钆布醇，并采集30分钟的MR图像。第二天，取出已识别的SLN并进行组织病理学评估。对MR淋巴造影和[锝]Tc-纳米胶体淋巴闪烁显像结果进行评估，并与SLN识别结果进行比较。参考标准包括对取出的SLN、补充性颈部清扫标本的组织病理学评估以及随访数据。MR淋巴造影在[锝]Tc-纳米胶体淋巴闪烁显像识别出的27个SLN中检测到16个，还发现了一个无转移的额外SLN。一名患者的MR淋巴造影未能识别出任何SLN。在[锝]Tc-纳米胶体淋巴闪烁显像检测到的7个组织病理学阳性SLN中，有3个被MR淋巴造影识别出。中位随访16个月后，所有患者均无疾病。与[锝]Tc-纳米胶体淋巴闪烁显像相比，使用钆布醇的MR淋巴造影的SLN识别率为59%，灵敏度为75%，阴性预测值为86%。使用钆布醇的MR淋巴造影在早期OSCC的SLN定位中显示出有限的可靠性。
