单光子发射计算机断层显像/CT在乳腺癌前哨淋巴结探测中的应用  

Sentinel lymph node identification by SPECT/CT in breast cancer

作　　者：卢承慧 王叙馥[1] 王国明[1] 刘新峰[1] 刘彬[1] 王国强[1] 王增华 Lu Chenghui;Wang Xufu;Wang Guoming;Liu Xinfeng;Liu Bin;Wang Guoqiang;Wang Zenghua(Department of Nuclear Medicine,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院核医学科,266003

出　　处：《中华乳腺病杂志（电子版）》2018年第1期27-31,共5页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨用放射性硫胶体(SC)单光子发射计算机断层显像(SPECT)/CT探测乳腺癌前哨淋巴结(SLN)的应用价值。方法按照入组和排除标准,收集2015年4~8月在青岛大学附属医院确诊的118例女性乳腺癌患者临床资料进行回顾性分析。患者术前行^(99)Tc^m-SC SPECT/CT联合术中蓝染法定位SLN,以联合法(SPECT/CT+蓝染法)检出结果为标准,比较单纯平面显像、蓝染法、SPECT/CT3种方法对SLN的检出率,并对所有检出的SLN送病理检查。组间SLN检出率(以病例数分析)的比较采用Fisher精确概率法,SLN检出率(以淋巴结数分析)的比较及SLN病理阳性率的比较采用配对χ~2检验。结果以联合法(SPECT/CT+蓝染法)检出结果为标准,从病例数角度分析,平面显像、SPECT/CT及蓝染法的SLN检出率分别为91.53%(108/118)、97.46%(115/118)和97.46%(115/118),差异有统计学意义(P=0.020),SPECT/CT及蓝染法的SLN检出率高于平面显像(χ~2=5.143、5.143,P=0.023、0.023)。从淋巴结数的角度分析,平面显像、SPECT/CT及蓝染法的SLN检出率分别为61.72%(158/256)、96.88%(248/256)和95.70%(245/256),差异有统计学意义(χ~2=158.072,P<0.001),SPECT/CT与蓝染法的SLN检出率也高于平面显像(χ~2=90.000、87.000,P<0.001)。对于腋窝区SLN,平面显像、SPECT/CT及蓝染法的检出率分别为64.44%(154/239)、96.65%(231/239)和100.00%(239/239),差异有统计学意义(χ~2=163.312,P<0.001),SPECT/CT与蓝染法均高于平面显像(χ~2=77.000、85.000,P均<0.001),蓝染法高于SPECT/CT(χ~2=6.125,P=0.013)。对于非腋窝区SLN,平面显像、SPECT/CT及蓝染法的检出率分别为4/17、17/17和6/17,差异有统计学意义(χ~2=23.139,P<0.001),SPECT/CT高于平面显像及蓝染法(χ~2=11.077、9.091,P=0.001、0.003)。SPECT/CT与蓝染法检出的SLN病理阳性率分别为24.22%(62/256)和21.09%(54/256),差异无统计学意义(χ~2=3.500,P=0.061)。对于腋窝区淋巴结,蓝染法比SPECT/CT多发现8枚,其中3枚SPECT/CT阴性的淋巴�Objective To evaluate the application of SPECT/CT with radioactive sulfur colloid(99 Tcm-SC)in detecting sentinel lymph nodes(SLNs)in breast cancer patients.Methods According to the inclusion and exclusion criteria,a total of 118 breast cancer patients in the Affiliated Hospital of Qingdao University from April 2015 to August 2015 were enrolled in this retrospective study.All patients underwent preoperative 99 Tcm-SC SPECT/CT combined with intraoperative blue dye tracing to detect SLNs.With the results of SPECT/CT plus blue dye tracing as the gold standard,the detection rate of SLNs by planar imaging,SPECT/CT or blue dye tracing alone was compared.All detected SLNs were sent to the pathologic examination.The detection rate of SLNs(based on cases)was compared using Fisher exact probability method,the detection rate of SLNs(based on node number)was compared using pairedX2 test,and the detection rate of pathologically positive SLNs by SPECT/CT and blue dye tracing was compared using paired X2 test.Results With the results of SPECT/CT plus blue dye tracing as the gold standard,the detection rate of SLNs(based on cases)by planar imaging,SPECT/CT or blue dye tracing alone was 91.53%(108/118),97.46%(115/118)and 97.46%(115/118)respectively,indicating a significant difference(P=0.020),and the detection rate by SPECT/CT or blue dye tracing was significantly higher than that by planar imaging(X2=5.143,5.143;P=0.023,0.023).The detection rate of SLNs(based on node number)by planar imaging,SPECT/CT and blue dye tracing was 61.72%(158/256),96.88%(248/256)and 95.70%(245/256)respectively,indicating a significant difference(X2=158.072,P<0.001).The detection rates by SPECT/CT and blue dye tracing was significantly higher than that by plane imaging(X2=90.000,87.000;both P<0.001).The detection rate of SLNs in axillary region by planar imaging,SPECT/CT and blue dye tracing was 64.44%(154/239),96.65%(231/239)and 100.00%(239/239)respectively,indicating a significant difference(X2=163.312,P<0.001).The detection rate of SLNs in axillary r

关 键 词：乳腺肿瘤 前哨淋巴结 放射性核素显像 

分 类 号：R737.9[医药卫生—肿瘤]