CAJ | 학술논문

目的：探讨99mTc 标记硫胶体（99mTc-SC）淋巴显像探测皮肤恶性黑色素瘤前哨淋巴结（SLN）的临床应用价值和影响因素。方法选取99例Ⅰ、Ⅱ期皮肤恶性黑色素瘤患者，术前4~6 h在肿瘤病灶周围皮下注射显像剂99mTc-SC，行早期局部及延迟全身显像，结合显像进行体表定位。随后行前哨淋巴结活检术（SLNB），对初诊患者加行原发病灶切除术，对SLN及原发病灶行详细病理检查。结果99mTc-SC的SLN总检出率为90.9%（90/99），检出率与原发灶部位有关（P＜0.001）；区间淋巴结检出率为7.1%（7/99）；SLN转移阳性率为28.9%（26/90），与肿瘤的病理组织学特点（Breslow厚度、Clark分级）呈正相关；假阴性率为3.7%（1/27），灵敏度为96.3%（26/27），特异度为98.4%（63/64）。结论99mTc-SC显像可准确显示SLN部位及淋巴引流情况，减少药物标记时间，进一步提高区域淋巴结检出，为恶性黑色素瘤区域淋巴结的诊治决策提供重要的临床依据。
목적：탐토99mTc 표기류효체（99mTc-SC）림파현상탐측피부악성흑색소류전초림파결（SLN）적림상응용개치화영향인소。방법선취99례Ⅰ、Ⅱ기피부악성흑색소류환자，술전4~6 h재종류병조주위피하주사현상제99mTc-SC，행조기국부급연지전신현상，결합현상진행체표정위。수후행전초림파결활검술（SLNB），대초진환자가행원발병조절제술，대SLN급원발병조행상세병리검사。결과99mTc-SC적SLN총검출솔위90.9%（90/99），검출솔여원발조부위유관（P＜0.001）；구간림파결검출솔위7.1%（7/99）；SLN전이양성솔위28.9%（26/90），여종류적병리조직학특점（Breslow후도、Clark분급）정정상관；가음성솔위3.7%（1/27），령민도위96.3%（26/27），특이도위98.4%（63/64）。결론99mTc-SC현상가준학현시SLN부위급림파인류정황，감소약물표기시간，진일보제고구역림파결검출，위악성흑색소류구역림파결적진치결책제공중요적림상의거。
Objective To evaluate the clinical value of lymphoscintigraphy using 99mTc- labeled sulphur colloid (99mTc-SC) in sentinel lymph node identification for cutaneous melanoma. Methods A total of 99 patients with stage Ⅰ-Ⅱ cutaneous melanoma were injected with 99mTc-SC before preoperative lymphoscintigraphy. The sentinel lymph nodes were identified by regional lymphoscintigraphy and gamma probe, followed by resection. Results The detection rate of sentinel lymph nodes was 90.9% (90/99) and well connected with the site of the primary lesions. The interval lymph nodes were found in 7.1%(7/99) patients. 28.9%(26/90) melanomas had positive sentinel lymph nodes and were positively correlated with the Breslow depth and Clark level. Conclusion 99mTc-SC lymphoscintigraphy could detect sentinel lymph nodes in the patients with stage Ⅰ-Ⅱ cutaneous melanoma and predict regional node status.