核素显像探测早期宫颈癌前哨淋巴结

目的探讨放射性核素显像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2005-03/2006-08间收治的42例早期宫颈癌患者,Ib1期21例,Ib2期17例,IIa期4例。术前注射T-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42例,SLN检出率为95.2%(40/42),共检出SLN91枚,平均每例2.28枚;9例病理检查有淋巴结转移,占22.5%。SLN检测的敏感性为88.9%,准确性为97.5%,阴性预测值为96.9%,假阴性率为11.1%。②40例中70.0%(28/40)的SLN位于双侧;91枚SLN中86.8%(79/91)位于闭孔和髂内,外血管区。结论SLN采用核素SPECT显像有较高的检出率;SLN的病理结果可以准确预测早期宫颈癌患者盆腔淋巴结的病理状态。

Clinical Application of Sentinel Lymph Node Detection with Radionuclide in Early Stage Cervical Cancer

Objective To investigate the clinical value of radionuclide technique for detecting sentinel lymph node (SLN),and to evaluate the accuracy of SLN in prediction of the pelvic lymph nodes status in patients with early stage cervical cancer.Methods During March 2005 to August 2006,a total of 42 patients with cervical cancer stage Ib1(n=21),stage Ib2(n=17),stage IIa(n=4)(classified by FIGO standard) were eligible for the study.The day before surgery, lymphoscintigraphy was performed with injection of 99m-technetium labeled dextran (99Tcm-DX),at a dose of about 74 MBq, into the uterine cervix. SLNs were identified intraoperatively using a handheld gammar-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 results of histopathology of SLNs and non-SLNs were compared.Results SLNs were successfully identified in 40 of 42 (95.2%)patients. A total of 91 SLNs were identified (mean, 2.3; range, 1-4). Eight (22.5%) patients had positive lymph nodes. Summarized sensitivity, accuracy, negative predictive value and false negative rate for SLN detection were 88.8%,97.5%,96.9%and 12.5%, respectively. In total, 79/91 (86.8%) of the SLNs were located in the area of the external and internal iliac artery and obturator fossa. Bilateral SLNs were detected in 28 (70.0%) 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.