淋巴管造影对前列腺癌淋巴结转移的诊断价值

目的　提高前列腺癌盆腔淋巴结转移的诊断水平。　方法　前列腺癌患者 33例 ,行足背淋巴管造影了解有无盆腔淋巴转移 ,造影结果与细针穿剌抽吸或淋巴结活检病理结果比较。　结果　淋巴结癌转移阳性 9例 ,7例经细针穿剌抽吸细胞学检查、6例经病理切片证实 ,无假阳性。 2 4例阴性中病理证实假阴性 4例 (17% )。　结论　淋巴管造影对前列腺癌淋巴结转移有很高的诊断价值 ,对可疑淋巴结细针穿剌抽吸细胞学检查可避免假阳性 ,但仍有假阴性。     

阴囊Merkel细胞癌一例报告

患者,65岁.发现左阴囊皮肤肿块2个月,左腹股沟肿块1周于2010年1月11日入院.查体:左阴囊根部皮肤见直径1.5 cm红色结节;左腹股沟可触及1枚肿大淋巴结,3 cm×2 cm×2 cm大小,质硬,固定,无压痛.CT检查示左腹股沟区域淋巴结肿大,PET-CT示左腹股沟淋巴结转移癌,未发现原发灶.腹股沟淋巴结活检报告转移性癌;左阴囊肿块活检报告阴囊恶性肿瘤.行阴囊肿块扩大切除加左腹股沟淋巴结清扫术,并切除左睾丸.手术顺利,术后出现淋巴漏,2周后好转.病理报告:阴囊皮肤Merkel细胞癌,肿瘤切缘阴性,左腹股沟淋巴结融合肿大,有癌转移;左睾丸精索未见癌转移.     

耻骨后根治性前列腺切除治疗淋巴结转移前列腺癌的疗效分析

目的:探讨耻骨后根治性前列腺切除结合辅助内分泌治疗或局部外放疗治疗20例前列腺癌伴盆腔淋巴结转移的安全性和疗效。方法:术前对20例前列腺癌患者均行双侧足背淋巴管造影,对其中11例盆腔可疑淋巴结穿刺抽吸淋巴液,进行实时定量PCR(RT-PCR)检测淋巴液PSA mRNA和前列腺特异膜抗原(PSMA)mRNA的表达。20例均行耻骨后根治性前列腺切除和扩大盆腔淋巴结清扫,对其中3例切端阳性者待尿失禁控制后给予外放疗。结果:11例经RT-PCR检测淋巴结液PSA mRNA和PSMA mRNA阳性表达中均经病理证实为前列腺癌淋巴结转移。术中失血量中位数575 ml,术中输血5例。手术切缘阳性3例,漏尿和淋巴漏各2例,无尿失禁、血管损伤和直肠损伤病例。经中位数42个月随访,术后6~48个月生化复发12例,复发时间中位数12个月。术后12个月和48个月分别死亡2例。结论:术前淋巴管造影后穿刺抽吸淋巴结液,用RT-PCR方法检测淋巴液PSA mRNA和PSMA mRNA表达有助于术前确定前列腺癌盆腔淋巴结转移。采用耻骨后根治性前列腺切除和扩大淋巴结清扫结合辅助内分泌治疗,对切端阳性者给予局部外放射治疗是治疗前列腺癌伴盆腔淋巴结转移患者安全、有效的方法。但对Gleason 10分的盆腔淋巴结转移前列腺癌采用根治性前列腺切除应慎重。     

盆腔前哨淋巴结示踪技术在前列腺癌根治术中的应用

盆腔淋巴结清扫是前列腺癌根治术(RP)的重要步骤,目前中高危患者进行的扩大盆腔淋巴结清扫(ePLND)可能导致过度医疗,延长手术时间,增加并发症的发生的风险,同时并非使患者都能从中受益。前哨淋巴结(SLN)被定义为从原发肿瘤转移的第一站淋巴结,清除SLN对整体淋巴结清扫至关重要,但是由于淋巴引流途径复杂多样,淋巴示踪技术精确性不足,SLN定位分布和清扫一直存在争议。本文综述了盆腔前哨淋巴结示踪技术在前列腺癌根治术中的应用。     

前列腺癌盆腔淋巴结转移的研究进展

前列腺癌是男性泌尿系统常见的恶性肿瘤之一,其生物学行为多变,其中,淋巴转移是前列腺癌的重要生物学特征,盆腔淋巴结是其常见的转移部位,一些前列腺癌在原发病灶尚小时(直径＜1cm)或局限于前列腺内时即可发生淋巴转移,表现出不良的预后.本文就前列腺癌盆腔淋巴结转移作一综述.     

18F-PSMA-1007 PET/CT和MRI-DWI鉴别前列腺癌患者盆腔淋巴结转移的价值

目的：探讨¹⁸F-前列腺特异性膜抗原(PSMA)-1007 PET/CT和磁共振弥散加权成像(MRI-DWI)对前列腺癌(PCa)盆腔淋巴结转移的鉴别价值。方法：回顾性分析2020年3月至2023年2月我院收治的45例PCa患者的临床病理资料,术前均接受¹⁸F-PSMA-1007 PET/CT和MRI-DWI扫描,获取最大标准化摄取值(SUVmax)、表观弥散系数(ADC)。根据术后病理检查结果确定转移淋巴结与非转移淋巴结,比较两组淋巴结的SUVmax、ADC,分析¹⁸F-PSMA-1007 PET/CT和MRI-DWI定量参数对盆腔淋巴结转移的鉴别诊断价值。结果：本研究共纳入45例PCa患者,术后病理诊断均为前列腺腺泡腺癌,共清扫盆腔淋巴结522枚,每例患者平均清扫(11.6±4.5)枚,术后病理证实盆腔淋巴结阳性率10.92%(57/522)。¹⁸FPSMA-1007 PET/CT检测出29例(64.44%)共79枚盆腔淋巴结转移,MRIDWI检测出17例(37.78%)共77枚盆腔淋巴结转移,...     

PSMA-SPECT/CT在前列腺癌转移灶检测中的应用价值

目的进一步提高前列腺癌转移灶的诊断水平。方法收集2015~2016年我院收治并接受前列腺特异性膜抗原(PSMA)-单光子发射计算机断层摄影术联合同机CT扫描图像融合技术(SPECT/CT)检查的前列腺癌患者,对其中3例典型患者的临床资料进行回顾性分析。结果 2例前列腺癌患者行前列腺癌根治术后,前列腺特异性抗原(PSA)水平未达到理想水平,MRI、CT以及骨扫描未能显示病灶,而PSMA-SPECT/CT可探测出这2例患者可疑转移淋巴结,1例位于右髂总血管旁,另1例位于左髂总血管旁及腹膜后淋巴结。1例并发膀胱癌的前列腺癌患者,左侧髂血管旁淋巴结肿大,病理来源不明,结合膀胱癌病理结果以及PSMA-SPECT/CT检查结果,推测髂血管旁淋巴结来源于前列腺癌可能性大,术后病理证实髂血管淋巴结转移来源于前列腺癌。结论本研究提示PSMA-SPECT/CT较现有影像学检查如MRI、骨扫描、CT等,可在PSA较低水平发现可疑前列腺癌转移灶。对于多器官肿瘤患者而言,若出现淋巴转移,PSMA-SPECT/CT可帮助判定淋巴转移病灶来源,从而指导临床治疗。     

间质磁共振淋巴造影技术在下肢淋巴水肿中的临床应用

目的 评价皮内注射顺磁性造影剂钆贝葡胺进行间质磁共振淋巴造影的可行性.方法 下肢淋巴水肿进展期患者10例共12侧患肢.在双足第1～4趾蹊背面皮内各注射钆贝葡胺1ml,共8 ml,选择三维容积内插快速绕相梯度回波,并行最大密度投影重建显示淋巴管和淋巴结.结果 10例12侧患肢中有11侧小腿段显示串珠状淋巴管,最佳强化时间在造影后15～30 min,大腿段显示6侧,最佳强化时间在造影后45 min.结论 间质磁共振淋巴造影是一种安全有效可行的显示淋巴水肿下肢淋巴管的新方法.     

在不能切除的肝胆胰癌肿中经皮经肝淋巴管造影以显示和治疗腹腔内淋巴结转移

196 3年 Moreno在经皮经肝胆道造影时应用实质内造影剂注射以显示肝淋巴。在超声扫描引导下 ,穿刺Glisson包膜 ,更可明确显影淋巴管。Sezai应用经皮经肝淋巴造影 (PTL)以显示肝细胞癌的淋巴转移。作者首先应用这一技术以治疗不能切除的淋巴结转移 ,在以往 4年中共为 13例病人 (肝细胞癌和胰腺癌各 5例 ,胃癌、胆囊癌和胆管癌各 1例 )施行了 16次 PTL,原发灶均不能切除 ,术后有淋巴结转移。在原发灶被控制的情况下 (如介入疗法 ) ,淋巴结转移成为重要的问题而需予以治疗。注射方法　病人仰卧 ,常规消毒 ,采用局麻。在超声扫描引导下 ,用 …     

实时定量逆转录PCR技术在前列腺癌微转移诊断中的应用进展

根治性前列腺切除术是早期前列腺癌的主要治疗手段,淋巴结转移是前列腺癌根治术后不良预后最有价值的预测指标,然而,有大约30%的经常规病理检查证实无盆腔淋巴结转移的病人术后发展为生化复发,许多研究认为是由于常规的病理检查未能发现盆腔淋巴结的微转移病灶.本文对前列腺癌盆腔淋巴结微转移病灶检测的实时定量逆转录PCR方法 应用进展作一.     

CT lymphography-navigated sentinel lymph node biopsy in patients with superficial esophageal cancer

BACKGROUND: To evaluate experimentally and clinically the feasibility of a newly developed technique of endoscopic computed tomography (CT) lymphography with endoscopic submucosal injection of iopamidol for esophageal sentinel lymph node (SLN) mapping and biopsy examination. METHODS: Nine anesthetized dogs underwent CT after endoscopic submucosal injection of 2 mL iopamidol; 1.25-mm thick CT images were obtained before and at 1, 3, 5, 7, and 10 minutes after contrast injection. Clinically, 12 patients with superficial esophageal cancer (preoperative imaging stage: cT1, cN0) underwent CT lymphography in a similar fashion at 1, 5, and 10 minutes after peritumoral injection, followed by radical esophagectomy and regional lymph node dissection under CT lymphography guidance. RESULTS: CT lymphography visualized the draining lymphatic vessels and SLNs within 5 minutes after contrast injection. All 14 SLNs in dogs (average, 1.5 nodes per animal; range, 1-2) and 28 SLNs in patients (average, 2.3 nodes per patient; range, 1-4) were found intraoperatively at the correct location under CT lymphography guidance. Lymph node metastasis could be detected with excellent sensitivity and accuracy in this small number of patients with no false-negative findings; metastasis was positive only in the preoperatively identified SLNs in 4 patients and in both SLNs and distant nodes in 1 patient, and was negative in all resected nodes in the remaining 7 patients. CONCLUSIONS: Endoscopic CT lymphography appears to allow accurate identification of direction and locations of lymph flow and SLNs, and has the potential clinical applicability for esophageal SLN mapping and biopsy examination, but will require a large study to determine its accuracy and usefulness.     

Bedeutung der radiologischen Bildgebung für die Lymphknotenchirurgie urologischer Malignome

This review illustrates the relevance of computed tomography (CT) and magnetic resonance imaging (MRI) for detecting or excluding lymph node metastases in urological malignancies. Although radiological assessment of lymph node metastases is well established in renal cell and testicular cancer, it is unreliable in prostate, bladder, and penile cancer. MR lymphography has shown promising results in these tumors, but because marketing authorization for the iron oxide contrast agent is lacking, it is not clinically applicable. Percutaneous CT-guided biopsy in the retroperitoneum and pelvis is introduced as an alternative in the histological exploration of suspicious lymph nodes.     

淋巴靶向性MR造影剂Dextran-Gd-DTPA对兔腘窝VX2肉瘤转移性淋巴结的诊断价值

目的 探讨新型淋巴靶向造影剂Dextran-Gd-DTPA对良、恶性淋巴结的鉴别诊断价值.方法 取12只新西兰大白兔(24个胭窝淋巴结)分成2组:正常组及VX2肉瘤腘窝淋巴结肿瘤转移组各6只.经双侧趾蹼间隙注射Dextran-Gd-DTPA后行MR增强扫描,计算标准化信号强度(SI)和增强率(En%).同时在体外检测Dextran-Gd-DTPA溶液中质子的自旋-晶格弛豫时间T1并计算R1值.结果 Dextran-Gd-DTPA的T1值为0.035 56 s,R1值为33.37·L(mmol·s)-1.正常组淋巴结明显强化,增强率约100%;VX2肉瘤转移性淋巴结表现为强化不明显,增强率为23%,两组差异有统计学意义.结论 Dextran-Gd-DTPA经组织间隙给药明显增强正常淋巴结,转移性淋巴结强化效应不明显,这种新型MR造影剂对鉴别良恶性淋巴结有重要价值.     

Interstitial CT lymphography-guided localization of breast sentinel lymph node: preliminary results

BACKGROUND: Accurate localization of the breast sentinel lymph node (SLN) can be challenging as a minimally invasive approach to the treatment of early-stage breast cancer. We tested the potential capability of interstitial computed tomographic lymphography (CT-LG) using a conventional contrast agent (iopamidol) for SLN mapping. METHODS: In 14 female dogs, 0.5 and 1 mL of undiluted iopamidol was injected subcutaneously into the 2 skin areas overlying the mammary gland. Contiguous, 2 mm-thick multidetector helical CT images were obtained through the upper breast and axilla before, and for 60 minutes after, gentle massage at the injection site. Three-dimensional (3D) CT images were obtained from the postcontrast images showing the greatest SLN enhancement. This CT-LG with 2 mL of iopamidol was also evaluated in 5 human female volunteers. RESULTS: The direct connection of SLN and lymphatic vessels draining from the injection sites in the animal models was clearly visualized, even with 0.5 mL of iopamidol. With this dose, the SLN attenuation was maximally enhanced, with a mean of 274 Hounsfield units (HU) on the first postcontrast images. The topographic 3D images provided the comprehensive anatomy of these lymphatic pathways. Of the 28 SLNs and 184 distant nodes visualized on CT images, all of the SLNs (100%) and 161 (87.5%) of the distant nodes could be resected at premortem and/or postmortem, with a good correlation in the locations and sizes with those on the CT images. The CT-LG effectively localized 5 SLNs with averaged maximum attenuation of 223 HU in the human volunteers, without any significant adverse effects. CONCLUSION: Interstitial CT-LG using small volumes of iopamidol can sufficiently visualize breast lymphatic drainage and may have potential utility for breast SLN mapping.     

大肠癌术中淋巴显影的临床应用

目的探讨术中用美兰作淋巴显影了解大肠癌的淋巴结转移情况的作用。方法术中美兰淋巴显影方法应用于２１例大肠癌患者。结果１１例肠系膜淋巴结显影良好的病例,术后淋巴结病检无１例转移;１０例显影不良的病例,术后病检有８例淋巴结转移。结论术中淋巴显影对术中淋巴清扫有一定的临床指导意义。     

逆向腋淋巴显影技术在乳腺癌患者中的临床运用及上肢回流淋巴结的分布与转移特点分析

目的研究逆向腋淋巴显影技术(ARM)在乳腺癌患者中的临床运用,分析乳腺癌患者上肢回流淋巴结的分布与转移特点。方法前瞻性选择2017年6月至2020年2月期间接受外科手术治疗的乳腺癌女性患者130例,所有患者均行ARM,且均为初次手术者。采用SPSS23.0进行统计学分析。术中上臂直径以(±s)表示,采用t检验;上肢回流淋巴结的转移单因素分析采用χ²检验分析,多因素分析采用Logistic回归分析,P<0.05差异有统计学意义。结果122例患者中501枚上肢回流淋巴结追踪成功,成功率为93.8%,A区和B区分别追踪327枚和106枚,共占83.1%,明显高于其他区域(P<0.05);而上肢回流淋巴结的行走方向以腋静脉、第二肋间臂神经、胸背神经血管束、背阔肌前缘以及前锯肌为界限,主要集中在腋静脉周围;单因素分析显示,患者腋窝淋巴情况、BMI指数、肿瘤分布位置、上臂直径与ARM技术上肢回流淋巴结转移有关(P<0.05),Logistic回归分析进一步表明,腋窝淋巴情况和肿瘤分布位置是ARM术上肢回流淋巴结转移的独立危险因素。结论ARM在乳腺癌手术中可成功定位淋巴结,通过了解淋巴分布位置和行走趋势,可提升淋巴系统保留的完整度,对降低术后淋巴水肿率,提高手术成功率有一定的意义。     

Percutaneous transhepatic lymphography method to image and treat intra-abdominal lymph node metastasis in patients with unresectable hepatobiliary pancreatic cancer

BACKGROUND: There have been no effective treatments for intra-abdominal lymph node metastasis. One of the main reasons is that we cannot deliver chemotherapeutic agents directly. We evaluated percutaneous transhepatic lymphography (PTL) as a drug delivery system. METHODS: PTL was performed 16 times in 13 patients. PTL was performed by puncture of the intrahepatic periportal area. Immediately after injection of contrast medium, lymphatic flow through the hepatoduodenal ligament to the intra-abdominal lymph nodes was visualized. The chemotherapeutic agent was delivered to the metastatic intra-abdominal lymph nodes by this route. RESULTS: In 10 of 13 patients, intrahepatic and extrahepatic lymphatic vessels and lymph nodes were visualized by PTL. Computed tomography after PTL showed retention of lipiodol in the lymphatic system around the portal vein and in the enlarged metastatic lymph nodes located in the pancreatic and celiac lymph nodes. According to the Response Evaluation Criteria in Solid Tumors, there were 8 patients with progressive disease and 5 with stable disease. CONCLUSIONS: The present study showed that PTL can be used as a drug delivery system specific for intra-abdominal lymph nodes as well as for identification of the lymph tracts.     

Percutaneous transabdominal fine needle aspiration of regional lymph nodes in genitourinary cancer

Percutaneous fine needle aspiration of retroperitoneal pelvic and abdominal lymph nodes was done in 21 patients with clinically localized bladder, prostate, or penile cancers. A diagnosis of metastases to regional lymph nodes was detected by this method in 6 patients, but only one case could be diagnosed by bipedal lymphography. Positive aspiration results may spare the patient with prostatic or bladder cancer an unnecessary radical operation. This method also enables the detection of micrometastasis of lymph node which can not be detected by lymphography. No complications were seen in this series.     

MRI在直肠癌术前分期中的作用

目的:评估盆腔MRI检查在直肠癌术前分期和治疗决策中的作用。方法:对2009年4月至2010年6月手术治疗的60例直肠癌病例的术前盆腔MRI检查结果与术后组织病理学诊断结果进行比较,分析MRI对直肠癌术前分期的准确率。结果:MRI对直肠癌浸润深度(T分期)的诊断准确率为75%,对T2期肿瘤的诊断准确率为73.1%,对T3期肿瘤的诊断准确率为86.7%;对淋巴结转移的诊断准确率为32.4%。在病理确诊淋巴结转移的16例病人中,MRI检出淋巴结平均数为5.8枚;在淋巴结转移阴性的44例病人中,MRI检出淋巴结平均数为2.4枚;两组淋巴结数有显著差异(P0.05)。结论:术前MRI检查可较准确地判断肿瘤在直肠壁的浸润深度,但对淋巴转移的诊断准确率较低,故MRI可作为直肠癌术前分期的方法,为新辅助治疗提供依据,为术后辅助化疗提供信息。     

Preoperative imaging of the lung sentinel lymphatic basin with computed tomographic lymphography: a preliminary study

BACKGROUND: Preoperative localization of the sentinel node basin would guide selective lymph node dissection. We tried to identify these nodal stations with indirect computed tomographic lymphography using a conventional extracellular contrast agent, iopamidol. METHODS: Eleven consecutive patients scheduled to undergo anatomic resection of suspected lung cancer, without lymphadenopathy, were given a peritumoral injection of undiluted iopamidol under computed tomography guidance, and lymphatic migration was assessed by multidetector-row helical computed tomography. RESULTS: There were no complications such as bleeding, pneumothorax, or allergic reactions. Enhanced nodes were detected in all but 1 patient who had diffuse lymph nodal calcification. Enhanced nodes were identified at 32 ipsilateral intrathoracic nodal stations (20 hilar stations and 12 mediastinal stations). The average length of the longer axis of the enhanced nodes was 4.8 mm (range, 3 to 8 mm), and the average attenuation of the enhanced nodes was 132 (range, 46 to 261) Hounsfield units. In 9 patients with confirmed lung cancer, enhanced nodes appeared at 26 nodal stations, and all apparent enhanced nodes were identified as actual lymph nodes at appropriate position during lymphadenectomy. None of the resected lymph nodes had metastatic involvement. CONCLUSIONS: Indirect computed tomographic lymphography with the peritumoral injection of iopamidol effectively depicts the drainage nodes unless they are diffusely calcified. Although further study is required, this method could guide selective lymph node dissection.