Szatkowski Wiktor, Pniewska Karolina, Blecharz Paweł, Nowak-Jastrząb Małgorzata, Ryś Janusz, Banaś Tomasz, Pacholczak-Madej Renata, Krzywonos Emilia, Rawojć Kamila, Kisielewicz Kamil
Department of Gynecological Oncology, Maria Skłodowska-Curie National Research Institute, Kraków Branch, Garncarska 11, 31-115 Krakow, Poland.
Department of Pathology, Maria Skłodowska-Curie National Research Institute, Kraków Branch, Garncarska 11, 31-115 Krakow, Poland.
Cancers (Basel). 2025 Sep 11;17(18):2976. doi: 10.3390/cancers17182976.
The preoperative detection of sentinel lymph nodes (SLN) using technetium-99m (Tc-99m) is crucial for surgical staging in early-stage endometrial cancer (EC). The optimal imaging timing and modality remain debated. This study compares early planar scintigraphy (30 min), SPECT/CT (1 h), and 18-h planar scintigraphy after a single Tc-99m injection. A total of 125 patients with early-stage EC underwent SLN mapping with Tc-99m (120 MBq). Imaging included 30-min planar scintigraphy, SPECT/CT (1 h), and 18-h planar scintigraphy on the day of surgery. Detection sensitivity, the bilateral mapping rate, and image quality (signal-to-noise ratio (SNR), contrast factor (C-factor)) were evaluated, with intraoperative gamma probe detection and histopathology as references. . Only the 18-h protocol underwent intraoperative and histopathological verification; results for 30-min planar and 1-h SPECT/CT were based on imaging alone, which limits direct comparability. Bilateral detection was higher at 18 h (80.80%) than SPECT/CT (73.60%). All SLNs detected at 18 h were confirmed intraoperatively and histologically, yielding 100% PPV (95% CI: 96.9-100.0%) and NPV (95% CI: 59.0-100.0%). The 18-h protocol showed superior imaging contrast (C-factor: 10.30 ± 1.22) despite lower residual activity. The method remained effective in patients with BMI ≥ 30 (94.00%). Only 1.60% of patients required hysterectomy before mapping due to background interference. The 18-h planar scintigraphy is a highly effective, low-cost, and accessible method for SLN detection in early-stage EC, potentially reducing the need for SPECT/CT, radiation exposure, and costs.
使用锝-99m（Tc-99m）术前检测前哨淋巴结（SLN）对于早期子宫内膜癌（EC）的手术分期至关重要。最佳成像时间和方式仍存在争议。本研究比较了单次注射Tc-99m后早期平面闪烁显像（30分钟）、SPECT/CT（1小时）和18小时平面闪烁显像。共有125例早期EC患者接受了Tc-99m（120MBq）前哨淋巴结定位。成像包括手术当天的30分钟平面闪烁显像、SPECT/CT（1小时）和18小时平面闪烁显像。以术中γ探测仪检测和组织病理学为参考，评估检测灵敏度、双侧定位率和图像质量（信噪比（SNR）、对比因子（C因子））。仅18小时方案进行了术中及组织病理学验证；30分钟平面显像和1小时SPECT/CT的结果仅基于成像，这限制了直接可比性。18小时时双侧检测率（80.80%）高于SPECT/CT（73.60%）。18小时时检测到的所有前哨淋巴结均在术中及组织学上得到证实，阳性预测值（PPV）为100%（95%CI：96.9-100.0%），阴性预测值（NPV）为100%（95%CI：59.0-100.0%）。尽管残留活性较低，但18小时方案显示出更好的成像对比度（C因子：10.30±1.22）。该方法在体重指数（BMI）≥30的患者中仍然有效（94.00%）。由于背景干扰，仅1.60%的患者在定位前需要进行子宫切除术。18小时平面闪烁显像对于早期EC前哨淋巴结检测是一种高效、低成本且易于使用的方法，可能减少对SPECT/CT的需求、辐射暴露和成本。
