| 张雯杰,郑容,吴令英,李晓光,陈盛祖.核素法探测前哨淋巴结在早期宫颈癌中的临床应用[J].中国医学影像技术,2005,21(9):1430~1433 |
| 核素法探测前哨淋巴结在早期宫颈癌中的临床应用 |
| Clinical application of sentinel lymph node detection with radionuclide in early stage cervical cancer |
| 投稿时间：2005-05-26 修订日期：2005-08-15 |
| DOI： |
| 中文关键词: 前哨淋巴结 宫颈肿瘤 淋巴转移 胶体类 |
| 英文关键词:Sentinel lymph node Cervix neoplasms Lymphatic metastasis Colloids |
| 基金项目:吴阶平医学基金会临床科研专项资助基金 (2003-43-N)。 |
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| 中文摘要: |
| 目的 探讨放射性核素定位法探测宫颈癌前哨淋巴结(SLN),并评价前哨淋巴结对早期宫颈癌盆腔淋巴结转移状况的预测价值。方法 2004年8月-2005年3月间收治的37例早期宫颈癌患者,Ⅰb1期19例,Ⅰb2期15例,Ⅱa期3例。术前注射99Tcm-右旋糖酐(DX),进行SLN显像;术中用γ探针探测放射性热点;对离体淋巴结再次进行探测,明确SLN。随后行广泛子宫切除＋盆腔淋巴结清扫术,所有切除的SLN及非SLN分别送常规病理检查。结果 ①本组37例病人,SLN检出率为97.3%(36/37)。36例病人共检出SLN 83枚,平均每例2.3枚。36例病人中,8例病人病理检查有淋巴结转移,占22.2%。SLN检测的敏感性为87.5%,准确性为97.2%,阴性预测值为96.6%,假阴性率为12.5%。②36例中69.4%(25/36)的病人SLN位于双侧;83枚SLN中89.2% (74/83) 位于闭孔和髂内、外血管区。③术前SPECT/CT融合图像较平面显像多检出4枚宫旁淋巴结。结论 术前SPECT/CT三维断层显像检测宫旁淋巴结优于平面显像,更能对SLN在术前进行准确定位;SLN的病理结果可以准确预测早期宫颈癌病人盆腔淋巴结的病理状态。 |
| 英文摘要: |
| Objective To investigate the clinical value of radionuclide technique for detecting sentinel lymph node (SLN), and to evaluate the accuracy of SLN in prediction of the pelvic lymph nodes status in patients with early stage cervical cancer. Methods Between August 2004 and March 2005, a total of 37 patients with cervical cancer international federation of obstetrics and gynaecology (FIGO) stageⅠb1 (n=19), stage Ⅰb2 (n=15), stage Ⅱa (n=3) were eligible for the study. The day before surgery, lymphoscintigraphy was performed with injection of 99m-technetium labelled dextran (99Tcm-DX), at a dose of about 74 MBq, into the uterine cervix. SLNs were identified intraoperatively using a handheld gamma-detecting probe. All surgically removed lymph nodes were reexamined with the gamma-detecting probe ex vivo. After resection of SLNs, a standard radical hysterectomy with pelvic lymph node dissection was performed. All surgically removed lymph nodes, including the SLNs, were examined histopathologically using routine hematoxylin and eosin (HE) staining. The Results of the histopathology of SLNs and non-SLNs were compared. Results SLNs were successfully identified in 36 of 37 (97.3%) patients. A total of 83 SLNs were identified (mean, 2.3; range, 1-4). Eight(22.2%) patients had positive lymph nodes. Summarized sensitivity, accuracy, negative predictive value and false negative rate for SLN detection were 87.5%, 97.2%, 96.6% and 12.5%, respectively. In total, 74/83 (89.2%) of the SLNs were located in the area of the external and internal iliac artery and obturator fossa. Bilateral SLNs were detected in 25 (69.4%) patients. Four SLNs in the parametrium were detected by preoperative SPECT/CT fusion images. Conclusion SPECT/CT imaging is not only superior to planar imaging in detecting parametrium SLN, but also enables precise localization of SLNs. SLNs detection can predict accurately the pelvic lymph nodes status in early stage cervical cancer. |
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