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甲状腺癌是最常见的内分泌系统恶性肿瘤,占恶性肿瘤的1.1%。近年来,甲状腺癌的发病率呈逐年上升的趋势[1-2]。甲状腺乳头状癌(papillary thyroid carcinoma,PTC)是分化型甲状腺癌最常见的一种类型,容易复发,区域淋巴结的转移率较高。Lundgren等[3]认为TNM分期,包括远处转移和淋巴结转移是影响PTC患者预后的重要因素。目前,对于有肉眼可见的淋巴结转移患者,建议行区域淋巴结清扫术,但对于临床淋巴结阴性(clinical N0,cN0)期的患者是否行预防性中央区和(或)侧颈区淋巴结清扫仍存在争议[4]。
前哨淋巴结(sentinel lymph node,SLN)是区域淋巴组织引流原发恶性肿瘤的第一站淋巴结(一枚或数枚),其在淋巴直接引流通路上,并且最靠近原发灶,有可能最先受到原发肿瘤的侵袭,但并不一定是已经发生肿瘤转移的淋巴结。检测SLN能预测原发肿瘤次级淋巴结的状态,有利于早期发现颈部隐匿性的淋巴结转移,以避免不必要的淋巴结清扫对甲状旁腺和喉返神经造成永久性伤害[5]。SLN的检测是评估PTC患者淋巴结转移的一种微创技术。
目前,应用放射性示踪技术检测cN0期PTC患者SLN尚未广泛应用于临床,国际上暂无明确标准。本研究前瞻性地利用SPECT/CT对16例cN0期PTC患者的SLN进行探测,以评估放射性示踪技术对cN0期PTC患者SLN定位的价值。
SPECT/CT在cN0期甲状腺乳头状癌前哨淋巴结定位中的应用价值
Assessment of SPECT/CT in sentinel lymph node location in cN0 papillary thyroid carcinoma
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摘要:
目的 评价SPECT/CT淋巴显像检测cN0期甲状腺乳头状癌(PTC)患者前哨淋巴结(SLN)的价值。 方法 选取2017年4月至11月在山西医科大学第一医院住院的16例淋巴结阴性(cN0)期PTC患者,其中男性2例、女性14例,年龄(47.0±8.4)岁,于手术前行99Tcm-硫体胶(99Tcm-SC)平面显像和SPECT/CT显像检测SLN。手术中使用γ探测仪探测放射性“热点”。将手术切除的SLN及颈部清扫标本进行病理学检查。 结果 16例患者术前 99Tcm-SC平面显像检出SLN 14例,检出率为87.50% (14/16)。术前99Tcm-SC平面显像、SPECT/CT显像分别检出31枚和35枚SLN。术中γ探测仪探测到SLN 13例,共计37枚,检出率为81.25% (13/16)。γ探测仪探测SLN数目与SPECT/CT淋巴显像数目有4例不一致,12例一致,两种方法的一致率为75% (12/16)。病理结果显示,15例患者有淋巴结转移,占93.75% (15/16)。SPECT/CT检测SLN的灵敏度为86.67% (13/15)、准确率为81.25% (13/16)、假阴性率为13.33% (2/15)。 结论 术前SPECT/CT淋巴显像能有效探测cN0期PTC患者的SLN,准确预测颈部淋巴结的转移情况。 -
关键词:
- 单光子发射计算机体层摄影术 /
- 前哨淋巴结 /
- 甲状腺乳头状癌
Abstract:Objective To evaluate the value of SPECT/CT lymphoscintigraphy for sentinel lymph node (SLN) detection in patients with cN0 papillary thyroid carcinoma(PTC). Methods From April to November 2017, 2 male and 14 female patients with cN0 PTC, with mean age of 47.0±8.4 years, and hospitalized in the first Hospital of Shanxi Medical University, were enrolled in this study. Planar and SPECT/CT SLN imaging were performed before operation. All patients underwent intraoperative lymphatic mapping with a handheld gamma probe. All specimens were sent to a pathology laboratory. Results Among the 16 patients, 14 cases of SLN were found, with a detection rate of 87.50% (14/16). Preoperative planar and SPECT/CT fusion images showed 31 and 35 SLNs, respectively. With the application of intraoperative gamma probe, a total of 37 SLNs were detected in 13/16 patients (81.25%). The number of SLNs detected by gamma detector was inconsistent with the SPECT/CT lymphography in 4 cases and consistent in 12 cases. The coincidence rate of the two methods was 75% (12/16). Fifteen patients (93.75%) had lymph node metastasis. The sensitivity, accuracy, and false negative rate of SLN detection were 86.67%, 81.25%, and 13.33%, respectively. Conclusion Preoperative SPECT/CT lymphoscintigraphy can not only enables precise localization of SLN but also detects the cervical lymph node metastasis in patients with cN0 papillary thyroid carcinoma. -
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