^99mTc—Dextran淋巴显像在恶性淋巴瘤诊断和治疗中的…

本文探讨了＾９９ｍＴｃ－Ｄｅｘｔｒａｎ淋巴显像在恶性淋巴瘤诊断和治疗中的应用。结果表明：（１）＾９９ｍＴｃ－Ｄｅｘｔｒａｎ淋巴显像有一定可靠性，对恶性淋巴瘤临床分期有较好应用价值，特别对腹膜后淋巴瘤更为重要，本组６３．５％病人改变了临床分期，可指导临床治疗和判断疗效。（２）＾９９ｍＴｃ－Ｄｅｘｔｒａｎ淋巴显像可确定淋巴瘤所在淋巴链中位置，同时对检测淋巴回流也是一种较好的方法，（３）本方法不需破坏淋     

恶性淋巴瘤治疗中~(99m)Tc脂质体腹膜后淋巴结显像的应用

近年来,国内外不少学者认为放射性核素淋巴结显像术乃是一种安全、简便、可靠的非创伤性的检查方法,在七十年代后期得到了迅速发展。~(99m)Tc—脂质体腹膜后淋巴结显像,对恶性淋巴瘤患者盆腔、腹膜后淋巴结受累的判断、放射治疗照射野的确定、药物疗效的随访等有一定的临床实用价值,特别适用于不宜作X线淋巴造影或造影术失败的患者。本文报道23例恶性淋巴瘤患者26次腹膜后淋巴结显像的结果。     

99Tc m硫胶体淋巴显像在妇科肿瘤术后下肢淋巴水肿诊断中的临床应用

目的:探讨 99Tc m硫胶体淋巴显像在妇科肿瘤术后下肢淋巴水肿诊断中的意义。 方法:回顾性分析2015年5月至2019年10月就诊于华中科技大学同济医学院附属协和医院的妇科肿瘤术后下肢淋巴水肿患者的临床资料。患者均进行 99Tc m硫胶体淋巴显像,分析淋巴管显...     

头颈部肿瘤蜘~(99)Tc-MIBI阳性显像的临床研究

目的探讨~(99m)Tc-MIBI亲肿瘤显像在头颈部肿瘤定性诊断中的应用价值。方法 91例临床初诊为头颈部肿瘤的患者和20例正常志愿者进行了早期和延迟的~(99m)Tc-MIBI头颈部断层显像。结果 ~(99m)Tc-MIBI早期／延迟显像诊断头颈部恶性肿瘤的总体灵敏度、特异性、准确性及阳性预测值分别为78.7％／72.3％、72.1％／ 88.4％、75.6％／80.0％和75.5％／87.2％；鼻咽癌、非霍奇金淋巴瘤显像效果优于上颌窦癌。~(99m)Tc-MIBI显像对于鼻咽癌复发／残留以及鼻腔非霍奇金淋巴瘤定性诊断价值明显优于CT和MRI检查。结论 ~(99m)Tc-MIBI亲肿瘤显像在头颈部肿瘤的定性诊断中有较好的应用前景,在判断肿瘤的范围、局部侵犯及发现颅底、颅内的转移灶等方面有独特的优势。     

骨髓细胞学检查对恶性淋巴瘤病理诊断、临床分期及预后价值

[目的]探讨骨髓细胞学检查对恶性淋巴瘤病理诊断和临床分期的价值.[方法]总结回顾101例恶性淋巴瘤患者的骨髓细胞学检查和临床分期结果.[结果]霍奇金淋巴瘤(HL)24例;非霍奇金淋巴瘤(NHL)77例.NHL分型:B细胞型49例,T细胞型26例和NK细胞型2例.恶性淋巴瘤的骨髓侵犯(BMI)32例(31.68%),其中恶性淋巴瘤性白血病(MLL)8例.HL的淋巴细胞削减型和混合细胞型;NHL的小淋巴细胞淋巴瘤,前B淋巴母细胞淋巴瘤和T淋巴母细胞淋巴瘤BMI多见.10例无明显浅表淋巴结肿大的NHL患者经骨髓活检确诊为BMI,分期则由原Ⅱ、Ⅲ期升为Ⅳ期.恶性淋巴瘤发展至MLL的间期＜3.5年,生存期＜28个月,预后不良.[结论]骨髓细胞学检查对恶性淋巴瘤的诊断和临床分期有重要价值,尤其对无淋巴结病理证据的患者可提供诊断依据,伴有BMI患者为临床晚期,可能进展为白血病.     

188Re-DTPA-DG治疗荷人乳腺癌裸鼠的疗效观察

~(18)F-脱氧葡萄糖(FDG)PET显像已用于多种肿瘤诊断、治疗和疗效评价,但由于费用较贵,从而限制了它的普及应用。陈跃等将DTPA连接在葡萄糖胺的氨基上,合成了DTPA-DG,并用~(99m)Tc标记DTPA-DG,放化纯度高(>99%),荷瘤鼠显像T/NT比值随时间延长而升高,显像效果满意。     

放射性核素评价骨转移病变

目前,原发性肿瘤骨转移的显像方面属放射性核素扫描最为敏感.70年代初期,由于~(99m)Tc 的出现,在放射性核素骨扫描方面出现了突破.~(99m)Tc 并不发射β射线,半衰期仅6小时,辐射剂量低,用~(99m)Tc 标记的各种化合物中,二磷酸盐类最易从血池中被清除掉。由于血液及骨外组织中放射性低,改善了图像及提高了诊断的正确性.锝标记的二磷酸盐是由化学吸附而进入骨的主要晶体-羟基磷灰石的磷酸基团上.     

核素显像诊断乳腺癌研究进展

无创伤性诊断乳腺肿瘤一直是临床研究热点。核素显像诊断乳腺癌近几年研究异常活跃,~(99m)Tc-甲氧基异丁基异腈(MIBI)乳腺显像对乳腺癌定性诊断、评价多药耐药现象及预测化疗效果有很高的临床价值；生长抑素受体显像与~(99m)Tc-MIBI显像相比有更广阔的应用前景。~(18)F脱氧葡萄糖正电子发射断层显像有很高的应用价值,但高昂的费用限制了其在临床的广泛应用。     

~(99m)Tc(Ⅴ)-DMSA在肿瘤诊断中的应用

五价锝标记的二巯基丁二酸 (99m Tc( ) -DMSA)是近年来研究较多的肿瘤阳性显像剂 ,其在甲状腺髓样癌、软组织肿瘤、头颈部肿瘤、骨转移瘤等多种恶性肿瘤的显像诊断中显示了较高的灵敏度和特异性 ,在恶性肿瘤诊断中有着广泛的应用前景。现对 99m Tc( ) -DMSA在肿瘤显像诊断中的应用予以综述     

恶性肿瘤应用骨髓检查的临床意义(综述)

骨髓检查对原发性骨髓疾病的诊断价值已为人们所熟知;本文主要复习近几年来骨髓检查应用于恶性肿瘤的有关文献,综述于后。一、骨髓检查对于恶性肿瘤的临床意义 1.恶性淋巴瘤恶性淋巴瘤骨髓检查的主要目的:首先是为了正确的临床分期,其次是为了恶性肿瘤特殊类型的诊断。 (1)临床分期: 为了提高恶性淋巴瘤的疗效和估计予后,要求正确的分期,以便选择最适宜的治疗方案。多数文献认为骨髓检查对恶性淋巴瘤的临床分期有重要价值。Gastellani等对已分期     

The effect of patient and tumour characteristics on visualization of sentinel nodes after a single intratumoural injection of Tc 99m labelled human albumin colloid in breast cancer

AIMS: The aim of the study was to study the influence of patient- or tumour-related factors on the lymphatic drainage patterns in breast cancer. METHODS: The study included 290 consecutive breast cancer patients with lymphatic mapping and sentinel node biopsy. Lymphoscintigraphy was performed a median of four hours after a single intratumoral injection of (99m)Tc labelled human albumin colloid with two different particle sizes. RESULTS: Lymphoscintigraphy showed axillary sentinel nodes in 253 (87%) and parasternal sentinel nodes in 49 (17%) patients. The median number of nodes seen in the axilla was one (range 0-5). No sentinel nodes were visualized in 27 (9%) patients. The number of the visualized axillary nodes was influenced by the particle size of the radiocolloid, and by metastatic involvement of the axillary nodes and the age and body mass index (BMI) of the patient. Patients with parasternal sentinel nodes were younger, had a lower BMI and had more often a non-palpable tumour. CONCLUSIONS: The age and BMI of the patient and the palpability of the tumour influence lymphatic drainage patterns in breast cancer. The metastatic involvement of axillary nodes seems to modify lymphatic drainage to the axilla.     

Technetium antimony sulfur colloid scintiscan in selective lymph node dissection for malignant melanoma

Lymphoscintigraphy with Technetium antimony sulfur colloid (TASC) was used in four patients with malignant melanoma to identify the pattern of lymphatic drainage, allowing selective lymph node dissection. TASC is safe and predictive of lymph node drainage patterns. Using this technique allows visualization of multiple tiers of lymph nodes in 2 to 6 hours.     

Sentinel lymph nodes with technetium-99m colloidal rhenium sulfide in patients with esophageal carcinoma

BACKGROUND: The authors assessed the detection of sentinel lymph nodes in patients with esophageal squamous cell carcinoma (SCC) using technetium-99m colloidal rhenium sulfide. They studied whether an analysis of sentinel lymph nodes using cytokeratin (CK) immunohistochemistry increased the accuracy of staging. METHODS: The authors observed 25 patients with thoracic esophageal carcinomas who underwent radical esophagectomy. The day before surgery, technetium-99m colloidal rhenium sulfide was injected into the submucosa at four sites around the primary tumor. Lymphoscintigraphy was performed. Esophagectomy and regional lymph node dissection were performed 17 hours after the technetium-99m injection. After surgery, the resected lymph nodes were evaluated by CK staining. RESULTS: Lymphoscintigraphy detected sentinel lymph nodes in 92% of the patients (23 of 25 patients). The accuracy of sentinel lymph node was 91.3% (21 of 23 patients), the sensitivity was 86.7% (13 of 15 patients), and the false-negative rate was 8.7% (2 of 23 patients). A comparison of the number of sentinel lymph nodes and clinicopathologic factors showed that there was a significant association between the number of sentinel lymph nodes and lymph node status (P < 0.01), pathologic stage (P < 0.05), and the number of metastatic lymph nodes (P < 0.05). Occult metastasis was detected by CK staining in 14 (56%) of the 25 patients and in 23 (1.7%) of 1406 lymph nodes. Because the 2 false-negative (sentinel lymph node-negative and nonsentinel lymph node-positive) patients who had occult metastases in the sentinel lymph nodes, the accuracy of sentinel lymph node evaluation using CK staining was 100% (23 of 23). CONCLUSIONS: Lymphatic mapping with technetium-99m colloidal rhenium sulfide was used to identify the lymphatic basin and was feasible in patients with esophageal SCC. An analysis of sentinel lymph nodes using CK immunohistochemistry increased the accuracy of sentinel lymph node.     

The impact of intradermal lymphoscintigraphy on surgical management of clinical stage I truncal malignant melanoma

Lymphoscintigraphy results in 35 stage I melanoma patients were compared with primary location and surgical management. Six of 25 primaries with potentially multidirectional lymphatic drainage had drainage to one regional node group. Three of 10 with expected unidirectional drainage showed multidirectional drainage. With unidirectional drainage, decision concerning lymphadenectomy was simplified.     

Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer.

AIMS: Lymphatic mapping and sentinel node (SN) biopsy in breast cancer contribute to more accurate staging, while using less invasive techniques. The aim of this study is to improve the accuracy and feasibility of this concept, increasing the identification rate of the SN, by using an alternative technique. METHODS: In 70 unselected patients with primary breast cancer, of whom 51% had undergone previous excisional biopsy, lymphatic mapping was performed using 10 mCi (370 MBq) 99mTc-nanocolloid peritumorally, combined with an intradermal blue dye tracer. RESULTS: Lymphoscintigraphy showed one or more SN in 97% and harvest of the SN was possible in all patients (identification rate 100%). Axillary metastases were found in 39%. Sensitivity of the SN biopsy was high, both after primary surgery (93%) and after previous surgery (100%). Internal mammary lymph node biopsy following lymphatic mapping was attempted in all 24 patients (34%) with parasternal SN visible on the scan and was successful in 15 patients, revealing metastatic involvement in five patients. CONCLUSIONS: We conclude that SN biopsy, using a higher dose of peritumoral radiocolloid tracer, combined with intradermal blue dye tracer, increases feasibility in breast cancer, making this concept applicable for all patients with primary breast cancer.     

Three-dimensional visualisation of lymphatic drainage patterns in patients with cutaneous melanoma

BACKGROUND: Lymphoscintigraphy accurately maps lymphatic drainage from sites of cutaneous melanoma to the draining sentinel lymph nodes. The Sydney Melanoma Unit has accumulated lymphoscintigraphy data from over 5000 patients with cutaneous melanoma over more than 15 years, collectively revealing patterns of skin lymphatic drainage. We aimed to map these data onto a three-dimensional computer model to provide improved visualisation and analysis of lymphatic drainage from sites of cutaneous melanoma. METHODS: Lymphoscintigraphy data from 5239 patients with cutaneous melanoma were collected between July 27, 1987 and Dec 16, 2005. 4302 of these patients had primary melanoma sites below the neck, and were included in this analysis. From these patients, two-dimensional lymphoscintigraphy data were mapped onto an anatomically based three-dimensional computer model of the skin and lymph nodes. Spatial analysis was done to visualise the relation between primary melanoma sites and the locations of sentinel lymph nodes. FINDINGS: We created three-dimensional, colour-coded heat maps that showed the drainage patterns from melanoma sites below the neck to individual lymph-node fields and to many lymph-node fields. These maps highlight the inter-patient variability in skin lymphatic drainage, and show the skin regions in which highly variable drainage can occur. To enable interactive and dynamic analysis of these data, we also developed software to predict lymphatic drainage patterns from melanoma skin sites to sentinel lymph-node fields. INTERPRETATION: The heat maps confirmed that the commonly used Sappey's lines are not effective in predicting lymphatic drainage. The heat maps and the interactive software could be a new resource for clinicians to use in preoperative discussions with patients with melanoma and other skin cancers that can metastasise to the lymph nodes, and could be used in the identification of sentinel lymph-node fields during follow-up of such patients.     

Lymphatic mapping and sentinel node biopsy in Merkel's cell carcinoma.

AIM: The purpose of this study was to determine the predictive value of lymphatic mapping with selective lymphadenectomy in patients with Merkel's cell carcinoma. METHODS: Eight patients with biopsy proven Merkel's cell carcinoma underwent sentinel node biopsy. Lymphoscintigraphy was performed the day before surgery following intradermal injection of 74-111MBq of 99mTc-nanocolloid divided into four doses around the biopsy scar. Dynamic and static images were obtained. RESULTS: At least one sentinel node was visualized in all patients. The sentinel node was intra-operatively identified with the aid of a hand-held gamma probe in all cases and patent blue dye in six out of eight cases. During surgery, all sentinel nodes were successfully harvested. Metastatic cell deposits were subsequently identified in three patients (37.5%) and they underwent regional lymphadenectomy. No additional involved lymph nodes were identified. No recurrence has been reported in a median follow-up of 4.6 years (range: 8 months-10 years). CONCLUSIONS: In conclusion, sentinel node biopsy in patients with Merkel's cell carcinoma appears to be a reliable staging technique.     

Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: A review of animal and clinical imaging studies

Upper extremity lymphoedema after axillary node dissection is an iatrogenic disease particularly associated with treatment for breast or skin cancer. Anatomical studies and lymphangiography in healthy subjects identified that axillary node dissection removes a segment of the lymphatic drainage pathway running from the upper limb to the sub-clavicular vein, creating a surgical break. It is reasonable to infer that different patterns of lymphatic drainage may occur in the upper limb following surgery and contribute to the various presentations of lymphoedema from none to severe.Firstly, we reviewed animal imaging studies that investigated the repair of lymphatic drainage pathways from the limb after lymph node dissection. Secondly, we examined clinical imaging studies of lymphatic drainage pathways after axillary node dissection, including lymphangiography, lymphoscintigraphy and indocyanine green fluorescence lymphography. Finally, based on the gathered data, we devised a set of general principles for the restoration of lymphatic pathways after surgery.Lymphoscintigraphy shows that restoration of the original lymphatic pathway to the axilla after its initial disruption by nodal dissection was not uncommon and may prevent lymphoedema. We found that regenerated lymphatic vessels and dermal backflow (the reflux of lymph to the skin) contributed to either restoration of the original pathway or rerouting of the lymphatic pathway to other regional nodes.Variation in the lymphatic drainage pathway and the mechanisms of fluid drainage itself are the foundation of new lymphatic drainage patterns considered to be significant in determining the severity with which lymphoedema develops.     

Lymphedema: How Do We Diagnose and Reduce the Risk of This Dreaded Complication of Breast Cancer Treatment?

Lymphedema is an under-recognized, progressive, life-long condition estimated to impact 2-3 million people in the United States. The incidence of breast cancer related lymphedema varies greatly in the literature largely due to different measurement techniques, competing thresholds for defining lymphedema, and variation in length of follow-up. Multiple imaging techniques have become useful for diagnosis. Lymphoscintigraphy is one of the most commonly used, as it can identify pathways of lymphatic drainage, quantify extent of dermal backflow, and help determine functional and morphologic changes in the lymphatic system. Early detection and intervention hold the greatest promise of reducing the incidence of lymphedema. Health care providers involved with cancer patients need to become more educated about lymphedema, aware of current risk-reduction practices, and familiar with methods of diagnosis and assessment, so that patients with early swelling can be referred to lymphedema treatment specialists at a time when treatment is more effective.     

Radioguided sentinel lymph node biopsy in patients with malignant cutaneous melanoma: the nuclear medicine contribution

As for other solid tumors, malignant cutaneous melanoma drains in a logical way through the lymphatic system, from the first to subsequent levels. Therefore, the first lymph node encountered (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it highly unlikely that other nodes in the same lymphatic basin are affected. Sentinel lymph node biopsy distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of lymphedema, and those with metastatic involvement who might benefit from additional therapy. This procedure represents a significant advantage as a minimally invasive procedure, considering that only an average 20% of melanoma patients with Breslow thickness between 1.5 and 4 mm harbour metastasis in their sentinel node(s) and are therefore candidates to elective lymph node dissection procedures. The cells that originate cutaneous melanomas are located between dermis and epidermis, a zone that drains to the inner lymphatic network in the reticular dermis, in turn to larger collecting lymphatics in subcutis. Therefore, the optimal modality of interstitial administration of radiocolloids for lymphoscintigraphy and subsequent radioguided sentinel lymph node biopsy is through intradermal/subdermal injection. (99m)Tc-labeled colloids in various size ranges are equally adequate for radioguided sentinel lymph node biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas located in the midline area of the head, neck, and trunk, particular consideration should be given to ambiguous lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy because images are used to direct the surgeon to the sites of the node(s). The sentinel lymph node should have a significantly higher count than that of background (at least 10:1 intraoperatively). After removal of the sentinel node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in melanoma patients is about 98% in institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. The procedure is becoming the standard of care for patients with cutaneous melanoma because of its high prognostic value that has led to include the procedure in the most recent version of the TNM staging system.