采用SPECT/CT及围手术期γ检测联合免疫组化对接受肺切除的非小细胞肺癌患者前哨淋巴结进行研究。
Investigation of sentinel lymph nodes using SPECT/CT and perioperative gamma assay combined with immunohistochemistry in non-small cell lung cancer patients undergoing lung resection.
作者信息
Çağan Pinar, Kimiaei Ali, Safaei Seyedehtina, Falay Fikri Okan, Kutlu Cemal Asim
机构信息
Department of Thoracic Surgery, Bahçeşehir University, Istanbul, Turkey.
Department of Nuclear Medicine, Faculty of Medicine, Koç University, Istanbul, Turkey.
出版信息
Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):874-881. doi: 10.1007/s12055-025-01924-9. Epub 2025 Mar 22.
PURPOSE
Accurate mediastinal staging is crucial for treatment planning and prognostication in patients with non-small cell lung cancer (NSCLC). Sentinel lymph node (SLN) detection using single-photon emission computed tomography/computed tomography (SPECT/CT) is a promising technique for improving the precision of mediastinal staging. In this study, we aimed to identify the lymph nodes that the tumor will invade based on the lobe in which it exists by determining the lobar drainage pathways. Additionally, we share our experience with the SLN procedure for NSCLC.
METHODS
The study included twenty NSCLC patients with N0, N1, or N2 stages, scheduled for surgery and showing no lymph node or distant metastasis on positron emission tomography/computed tomography (PET/CT). Radiopharmaceutical injection around the tumor preoperatively was followed by SPECT/CT visualization. Lymph nodes were counted using a gamma probe post-mediastinal dissection. Evaluation included histopathological analysis of SLNs identified by SPECT/CT and gamma probe, using hematoxylin and eosin and immunohistochemical staining.
RESULTS
After postoperative pathological examinations, metastases were found in other mediastinal, hilar, or intrapulmonary lymph nodes without involving the SLN in six patients (30%). Metastasis to the SLN was detected in only two patients (10%). Immunohistochemical staining with cytokeratin revealed SLN metastasis in three patients (15%). The skip metastasis was detected in five patients (25%). Additionally, three patients (15%) experienced pneumothorax post transthoracic radiopharmaceutical injection, which did not require intervention, and one patient (5%) had hemoptysis.
CONCLUSION
We propose that enhancing SLN detection in NSCLC can aid surgeons in selectively sampling lymph nodes that are either invaded or are at risk of invasion without sacrificing the accuracy of mediastinal staging.
CLINICAL TRIAL REGISTRATION
Not applicable. This manuscript does not report on or involve the use of any clinical trials.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12055-025-01924-9.
目的
准确的纵隔分期对于非小细胞肺癌（NSCLC）患者的治疗规划和预后评估至关重要。使用单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）检测前哨淋巴结（SLN）是一种有前景的技术，可提高纵隔分期的准确性。在本研究中，我们旨在通过确定肺叶引流途径，根据肿瘤所在肺叶来识别肿瘤可能侵犯的淋巴结。此外，我们分享我们在NSCLC的SLN手术方面的经验。
方法
本研究纳入了20例N0、N1或N2期的NSCLC患者，这些患者计划接受手术，且在正电子发射断层扫描/计算机断层扫描（PET/CT）上未显示淋巴结或远处转移。术前在肿瘤周围注射放射性药物，随后进行SPECT/CT显像。纵隔清扫术后使用γ探针计数淋巴结。评估包括对通过SPECT/CT和γ探针识别出的SLN进行苏木精和伊红染色以及免疫组织化学染色的组织病理学分析。
结果
术后病理检查发现，6例患者（30%）在其他纵隔、肺门或肺内淋巴结有转移，但未累及SLN。仅2例患者（10%）检测到SLN转移。细胞角蛋白免疫组织化学染色显示3例患者（15%）有SLN转移。5例患者（25%）检测到跳跃转移。此外，3例患者（15%）在经胸放射性药物注射后发生气胸，无需干预，1例患者（5%）出现咯血。
结论
我们提出，加强NSCLC的SLN检测可帮助外科医生在不牺牲纵隔分期准确性的情况下，选择性地对已受侵犯或有侵犯风险的淋巴结进行采样。
临床试验注册
不适用。本手稿未报告或涉及任何临床试验的使用。
补充信息
在线版本包含可在10.1007/s12055-025-01924-9获取的补充材料。
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