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甲状腺癌是最常见的内分泌系统恶性肿瘤,近年来其发病率迅速上升。2019年1月,国家癌症中心发布的统计数据显示,2015年我国新发恶性肿瘤中甲状腺癌占5.12%,在女性高发恶性肿瘤中居第4位[1]。DTC包括甲状腺乳头状癌(papillary thyroid cancer,PTC)、甲状腺滤泡状癌(follicular thyriod cancer,FTC)和甲状腺嗜酸细胞癌(Hürthle cell cancer,HTC)。颈部淋巴结是DTC最常见的转移部位,国内131I治疗分化型甲状腺癌指南(2021版)[2]指出,区域淋巴结转移与否对DTC,尤其是PTC的总生存期和疾病特异性生存期的影响较小,尤其是在随访时间短于10年的研究中。但是淋巴结转移可能会增加DTC的局部复发或远处转移的风险。有研究者认为,颈部淋巴结转移是DTC局部复发率和发病率升高的独立危险因素[3],且手术时是否能够规范清扫局部转移淋巴结也是影响疾病复发风险的重要因素。虽然大多数PTC预后良好,但仍有部分患者会因早期局部周围组织受累及多区域淋巴结转移而出现局部复发或转移。因此,局部病灶复发和区域或远处转移仍然是PTC治疗失败和患者死亡的主要原因[4]。虽然DTC患者在甲状腺切除术后出现隐匿性淋巴结转移的概率较高,但经131I治疗后,借助功能性淋巴结转移灶的摄碘特性和CT的解剖形态学诊断优势,运用131I全身显像(whole body scan,WBS)联合SPECT/CT(简称131I SPECT/CT)能够发现和定位可能的转移性淋巴结,从而改变DTC的术后再分期及危险度分层,改善后续的治疗方式或随访管理。因此,淋巴结转移的检测对于DTC治疗方式的选择具有重要意义。本文将对131I SPECT/CT在DTC术后淋巴结转移的诊断及治疗中的应用价值进行综述。
131I SPECT/CT在分化型甲状腺癌术后淋巴结转移中应用价值的研究进展
Research progress on the application value of 131I SPECT/CT in postoperative lymph node metastasis in patients with differentiated thyroid cancer
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摘要: 分化型甲状腺癌(DTC)是最常见的内分泌系统恶性肿瘤,早期易发生淋巴结转移。131I全身显像联合SPECT/CT(简称131I SPECT/CT)常可发现残留和(或)漏诊的淋巴结转移灶,可能会改变患者的术后再分期及危险度分层,从而影响后续的手术或131I治疗的方式选择。131I治疗是DTC术后颈部淋巴结转移的有效治疗方法之一,而131I SPECT/CT可以诊断淋巴结转移灶。笔者对131I SPECT/CT在DTC术后淋巴结转移的诊断及治疗中的应用价值进行综述。
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关键词:
- 碘放射性同位素 /
- 分化型甲状腺癌 /
- 近距离放射疗法 /
- 淋巴转移 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机
Abstract: Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, which is prone to lymph node metastasis in the early stage. 131I whole body scan combining with SPECT/CT (called 131I SPECT/CT for short) can often detect residual and/or missed lymph node metastasis, which may change the postoperative staging and risk stratification of patients, affect subsequent surgical or 131I therapy options. 131I therapy is one of the effect methods for the treatment of postoperative cervical lymph node metastasis in DTC. Metastatic lymph nodes can be diagnosed by 131I SPECT/CT. This article reviews the application value of 131I SPECT/CT in the diagnosis and treatment of postoperative lymph node metastasis in patients with differentiated thyroid cancer. -
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