99Tcm－利妥昔单克隆抗体原发乳腺癌前哨淋巴结平面显像与SPECT/CT断层显像的对比  

Comparison of 99Tcm-rituximab planar and SPECT/CT lymphoscintigraphy for sentinel lymph nodes of breast cancer

作　　者：李囡[1] 苏华[1] 赵起超[1] 王风[1] 范洋[1] 朱华[1] 翟士桢[1] 杨志[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所核医学科、恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华核医学与分子影像杂志》2016年第6期495-499,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的 通过对原发乳腺癌患者SLN平面显像和SPECT/CT断层显像的自身对比研究，了解SPECT/CT在SLN术前定位和显示方面的优势和应用价值。方法 2015年5月至2015年12月，对104例Ⅰ～Ⅱ期原发性乳腺癌患者[女性，年龄59.71±12.33（33～82）岁]在超声引导下于乳腺肿块周围及肿块表面皮下注射99Tcm－利妥昔单克隆抗体（简称单抗）18.5 MBq（0.5 ml），2 h后乳腺外科医师手持便携式γ探测器于腋窝区体表初探SLN结果不理想，遂于注射后2～4 h行SLN平面显像和SPECT/CT显像。活组织检查（简称活检）术中手持便携式γ探测SLN，对切取的SLN行常规HE染色及免疫组织化学检查。数据比较行χ2检验和配对t检验。结果 104例患者SLN平面显像和断层显像的成功率分别为88.46%（92/104）和98.08%（102/104），差异有统计学意义（χ2＝7.658，P〈0.05）。显像阴性者多见于年长、有新辅助化疗史或SLN有转移的患者。平面和断层显像分别显示SLN 122枚和166枚，平均为（1.17±0.73）和（1.60±0.95）枚（t＝2.533，P〈0.01）。SLN显影部位有腋窝区、内乳区及胸肌间。断层显像比平面显像有效剂量增加（3.41±0.59） mSv。活检术中手持便携式γ探测器共探测到84例患者的腋窝区和（或）胸肌间SLN 174枚，病理学确诊SLN转移17例、46枚淋巴结。结论 SPECT/CT断层显像显示SLN比平面显像更清晰、定位更准确、成功率更高，可帮助临床进行乳腺癌SLN活检。Objective To investigate the advantages of SPECT/CT in preoperative SLN localization of primary breast cancer by comparing with planar lymphoscintigraphy in the same patient.Methods From May 2015 to December 2015, 104 female patients （age range： 33-82 years, average age（59.71±12.33）years） with stageⅠ-Ⅱbreast cancer had preoperative peritumoral injection of 18.5 MBq （0.5 ml） of 99Tcm-rituximab under the guidance of ultrasound. Planar and SPECT/CT lymphoscintigraphy were acquired at 2-4 h post injection since SLN detection was difficult on skin of axilla by a handheld portable detector at 2 h after injection. Axillary SLNs were detected by a handheld portable detector and examined pathologically with both HE and immunohistochemical staining. χ2 test and paired t test were used for data analysis.Results The success rate of planar imaging and SPECT/CT was 88.46%（92/104） and 98.08%（102/104）, respectively, with statistically significant difference （χ2=7.658, P〈0.05）. Negative imaging was more common in older patients, or those with history of neoadjuvant chemotherapy or metastatic SLNs. The numbers of SLNs detected by the 2 imaging methods were 122 vs 166 or （1.17±0.73）/patient vs （1.60±0.95）/patient （t=2.533, P〈0.01）. SLNs were found in axilla, internal mammary and interpectoral stations. The patients received an additional （3.41±0.59） mSv effective dose in SPECT/CT compared with planar imaging. A total of 174 axillary fossa and/or interpectoral SLNs were harvested by a handheld portable gamma detector in 84 cases, and 46 SLNs in 17 patients were pathologically confirmed as metastasis. Conclusion SPECT/CT could detect more SLNs and is more accurate than planar lymphoscintigraphy, suggesting that it is useful in SLN biopsy of breast cancer.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 体层摄影术 发射型计算机 单光子 体层摄影术 x线计算机 抗体 单克隆 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]