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SLN83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。
Objective To investigate the clinical value of radionuclide technique for detecting sentinel lymph node （SLN）, and to evaluate the accuracy of SI.N 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 oh stetrics and gynaecology （FIGO） stage I b1（n=19）, stage I b2（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 （^99Tc^m-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 resuhs of the histopathology of SI.Ns 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 theSI.Ns were located in the area of the external and internaliliac artery and ohturator 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.
出处
《中国医学影像技术》
CSCD
北大核心
2005年第9期1430-1433,共4页
Chinese Journal of Medical Imaging Technology
基金
吴阶平医学基金会临床科研专项资助基金(200343N)。
关键词
前哨淋巴结
宫颈肿瘤
淋巴转移
胶体类
Sentinel lymph node
Cervix neoplasms
Lymphatic metastasis
Colloids
