中华核医学杂志
中華覈醫學雜誌
중화핵의학잡지
CHINESE JOURNAL OF NUCLEAR MEDICINE
2009年
1期
12-15
,共4页
宫颈肿瘤%淋巴结%放射性核素显像%亚甲蓝%肿瘤转移%99m锝硫胶
宮頸腫瘤%淋巴結%放射性覈素顯像%亞甲藍%腫瘤轉移%99m锝硫膠
궁경종류%림파결%방사성핵소현상%아갑람%종류전이%99m득류효
Cervix neoplasms%Lymph nodes%Radionuclide imaging%Methylene blue%Neoplasm metastasis%Technetium Tc 99m sulfur colloid
目的 探讨用前哨淋巴结(SEN)核素-染料联合检测术检出早期宫颈癌的可行性及其应用价值.方法 选择2005年3月～2006年4月本院收治的50例按国际妇产科学联盟(FIFO,1994年)标准诊断为Ⅰ b～Ⅱa期宫颈癌患者,于肿瘤旁3点钟和9点钟位置各对称注射99Tcm-硫胶体148 MBq(4×10-4 L)后15～60 min行SLN显像;术中用γ探测器探测"热点"淋巴结,并于瘤旁3点钟和9点钟位置注射亚甲蓝2～4 ml,记录蓝染淋巴结和"热点"淋巴结数目和部位,再行广泛子宫切除和盆腔淋巴结清扫术及淋巴结病理检查,分析SLN检出率、病理检查结果及与非SLN(NSLN)的关系等.采用SPSS 13.0软件进行统计学处理.结果 50例患者核素-染料联合法SLN检出率96.0%(48/50),核素法SLN检出率92.0%(46/50),染料法检出率70.0%(35/50),后两者差异有统计学意义(X2= 4.92,P<0.05).核素法中有37例显像结果与术中～探测结果一致,符合率为74.0%(37/50).48例核素-染料联合法检出SLN的患者中,有11例(22.9%)SLN病理检查常规HE染色显示转移,余37例中有1例SLN未显示转移而NSLN显示转移.2例未检出SLN患者中,有1例出现NSLN转移,联合法对SLN探测准确性为97.9%(47/48),假阴性1例,阴性预测值为97.3%(36/37).共159枚SLN中,分布于闭孔淋巴结115枚(72.3%),髂内淋巴结8枚(5.0%),髂外淋巴结19枚(12.0%),髂总淋巴结11枚(6.9%),宫旁淋巴结6枚(3.8%),左侧SLN总数(90枚)多于右侧(69枚),且差异有统计学意义(X2=5.06,P=0.021).结论 核素-染料联合法检测早期宫颈癌SLN是可行的,且其在预测盆腔淋巴结有无转移等方面具有一定的应用价值.
目的 探討用前哨淋巴結(SEN)覈素-染料聯閤檢測術檢齣早期宮頸癌的可行性及其應用價值.方法 選擇2005年3月～2006年4月本院收治的50例按國際婦產科學聯盟(FIFO,1994年)標準診斷為Ⅰ b～Ⅱa期宮頸癌患者,于腫瘤徬3點鐘和9點鐘位置各對稱註射99Tcm-硫膠體148 MBq(4×10-4 L)後15～60 min行SLN顯像;術中用γ探測器探測"熱點"淋巴結,併于瘤徬3點鐘和9點鐘位置註射亞甲藍2～4 ml,記錄藍染淋巴結和"熱點"淋巴結數目和部位,再行廣汎子宮切除和盆腔淋巴結清掃術及淋巴結病理檢查,分析SLN檢齣率、病理檢查結果及與非SLN(NSLN)的關繫等.採用SPSS 13.0軟件進行統計學處理.結果 50例患者覈素-染料聯閤法SLN檢齣率96.0%(48/50),覈素法SLN檢齣率92.0%(46/50),染料法檢齣率70.0%(35/50),後兩者差異有統計學意義(X2= 4.92,P<0.05).覈素法中有37例顯像結果與術中～探測結果一緻,符閤率為74.0%(37/50).48例覈素-染料聯閤法檢齣SLN的患者中,有11例(22.9%)SLN病理檢查常規HE染色顯示轉移,餘37例中有1例SLN未顯示轉移而NSLN顯示轉移.2例未檢齣SLN患者中,有1例齣現NSLN轉移,聯閤法對SLN探測準確性為97.9%(47/48),假陰性1例,陰性預測值為97.3%(36/37).共159枚SLN中,分佈于閉孔淋巴結115枚(72.3%),髂內淋巴結8枚(5.0%),髂外淋巴結19枚(12.0%),髂總淋巴結11枚(6.9%),宮徬淋巴結6枚(3.8%),左側SLN總數(90枚)多于右側(69枚),且差異有統計學意義(X2=5.06,P=0.021).結論 覈素-染料聯閤法檢測早期宮頸癌SLN是可行的,且其在預測盆腔淋巴結有無轉移等方麵具有一定的應用價值.
목적 탐토용전초림파결(SEN)핵소-염료연합검측술검출조기궁경암적가행성급기응용개치.방법 선택2005년3월～2006년4월본원수치적50례안국제부산과학련맹(FIFO,1994년)표준진단위Ⅰ b～Ⅱa기궁경암환자,우종류방3점종화9점종위치각대칭주사99Tcm-류효체148 MBq(4×10-4 L)후15～60 min행SLN현상;술중용γ탐측기탐측"열점"림파결,병우류방3점종화9점종위치주사아갑람2～4 ml,기록람염림파결화"열점"림파결수목화부위,재행엄범자궁절제화분강림파결청소술급림파결병리검사,분석SLN검출솔、병리검사결과급여비SLN(NSLN)적관계등.채용SPSS 13.0연건진행통계학처리.결과 50례환자핵소-염료연합법SLN검출솔96.0%(48/50),핵소법SLN검출솔92.0%(46/50),염료법검출솔70.0%(35/50),후량자차이유통계학의의(X2= 4.92,P<0.05).핵소법중유37례현상결과여술중～탐측결과일치,부합솔위74.0%(37/50).48례핵소-염료연합법검출SLN적환자중,유11례(22.9%)SLN병리검사상규HE염색현시전이,여37례중유1례SLN미현시전이이NSLN현시전이.2례미검출SLN환자중,유1례출현NSLN전이,연합법대SLN탐측준학성위97.9%(47/48),가음성1례,음성예측치위97.3%(36/37).공159매SLN중,분포우폐공림파결115매(72.3%),가내림파결8매(5.0%),가외림파결19매(12.0%),가총림파결11매(6.9%),궁방림파결6매(3.8%),좌측SLN총수(90매)다우우측(69매),차차이유통계학의의(X2=5.06,P=0.021).결론 핵소-염료연합법검측조기궁경암SLN시가행적,차기재예측분강림파결유무전이등방면구유일정적응용개치.
Objective The aim of this study was to investigate the feasibility and clinical value of detecting sentinel lymph node (SLN) with combined radioisotope and blue dye method in early stage cervical cancer. Methods Between March 2005 and April 2006, 50 patients with cervical cancer, who were staged Ⅰ b and Ⅱ a by International Federation of Gynecology and Obstetrics (FIGO), underwent SLN detection with preoperative lymphoscintigraphy. A dose of 148 MBq (4×10-4L) 99Tcm-sulfur colloid (SC) was injected into the uterine cervix at 3 and 9 o'clock position with lymphoscintigraphy taken at 15-60 min after injection. Intraoperative detection of "hot spot" lymph nodes was performed with a handheld gamma probe (γ-detection). During operation, 2-4 ml metend blue dye (BD-detection) was injected into the uterine cervix at the same positions. All patients underwent hysterectomy and pelvic lymphadenectomy. The spatial and pathological relationships of the SLN samples were compared between the two methods. SPSS 13.0 was used for statistical analysis. Results The detection rate of SLN with combined radioisotope and blue dye was 96.0% (48/50). γ-detection alone was 92.0% (46/50) and BD-detection alone was 70.0% (35/50, x2=4.92, P<0.05). In 37 patients lymphoseintigraphy showed the same SLN as γ-detection did, with a coincidence rate of 74.0% (37/50). The SLN with metastases were confirmed by histopathology in 11/48 (22.9%) patients. In the remaining 37 patients with SLN negative for metastasis, there was 1 case with non-SLN showing metastasis. In the 2 patients negative for SLN, 1 was positive for non-SLN metastasis. The SLN accuracy rate was therefore 97.9% (47/48), and the negative predictive value was 97.3% (36/37) with one patient false negative. About 72.3 % (115/159) of SLN were found in obturator region, 5.0% (8/ 159) in iuteriliac region, 12.0% (19/159) in external iliac chain, 6.9% (11/159) in common iliac region and 3.8% (6/159) in parametrium. The number of left-sided SLN detected was more than that of the right (x2=5.06, P=0.021 ). Conclusion Combined radioisotope and blue dye technique is a feasible and valuable tool to detect pelvic SLN in patients with early uterine cervical malignancy.
