^(99m)Tc-SC显像结合3D融合模式在乳腺癌前哨淋巴结活检中的价值  

Value of ^(99m)Tc-SC lymphoscintigraphy combined with 3D fusion mode in sentinel lymph node biopsy of breast cancer

作　　者：杨俊杰 王玮 付博岩 白俊文[2] YANG Junjie;WANG Wei;FU Boyan;BAI Junwen(Graduate School of Inner Mongolia Medical University,Hohhot,Inner Mongolia 010110,China;Department of Thyroid and Breast Surgery,Affiliated Hospital of Inner Mongolia Medical University,Hohhot,Inner Mongolia 010110,China)

机构地区：[1]内蒙古医科大学研究生院,内蒙古呼和浩特010110 [2]内蒙古医科大学附属医院甲状腺乳腺外科,内蒙古呼和浩特010010

出　　处：《中华肿瘤防治杂志》2023年第21期1301-1307,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：内蒙古自治区高等学校科学研究(NJZY22642)。

摘　　要：目的 探讨锝-99m(^(99m)Tc)-硫胶体(SC) SPECT/CT淋巴显像术前评估前哨淋巴结(SLN)转移风险的价值,并结合3D融合模式定位SLN,探寻SLN的分布规律。方法 选取2020-01-01-2022-12-31内蒙古医科大学附属医院收治的拟行前哨淋巴结活检术(SLNB)且术前行^(99m)Tc-SC SPECT/CT淋巴显像的女性乳腺癌患者288例。采用单因素及多因素logistic回归分析方法分析与SLN转移有关的淋巴显像及临床病理因素。淋巴显像阳性的患者使用3D融合重建技术重建皮肤和骨骼,再应用腋窝体表标线及肋间隙对SLN进行定位。结果 共有59例(20.49%)患者SLN发生转移。单因素分析结果显示,年龄(χ^(2)=4.318,P=0.038)、月经状态(χ^(2)=8.090,P=0.004)和SPECT/CT显像个数(χ^(2)=5.631,P=0.018)与SLN转移有关联。多因素分析结果显示,SPECT/CT显像个数(OR=2.387,95%CI:1.137~5.013,P=0.022)对SLN转移有诊断价值。当SPECT/CT淋巴显像个数≤1枚时,SLN转移率为24.14%(49/203);当SPECT/CT淋巴显像个数>1枚时,SLN转移率为11.76%(10/85)。SPECT/CT淋巴显像法诊断SLN转移的灵敏度为83.05%(49/59),特异度为32.75%(75/229)。淋巴显像阳性的204例患者中,“最热”SLN分布于腋中线附近最多,其次为腋前线和腋后线附近;“最热”SLN分布于第2肋间隙最多,其次为第1、3、4和5肋间隙。结论 ^(99m)Tc-SC SPECT/CT淋巴显像在术前评估SLN转移风险方面具有一定价值,其诊断SLN转移的灵敏度较高。^(99m)Tc-SC SPECT/CT淋巴显像结合3D融合模式可用于SLN定位,绝大多数SLN分布于腋前线、腋中线与第1~3肋间隙围成的四边形区域内。Objective To explore the value of Technetium-99m(^(99m)Tc)-sulfur colloid(SC) SPECT/CT lymphoscintigraphy in preoperative assessment of the risk of sentinel lymph node(SLN) metastasis,and to explore the distribution of SLN by combining 3D fusion mode to locate SLN.Methods A total of 288 breast cancer patients who underwent ^(99m)Tc-SC SPECT/CT lymphoscintigraphy before sentinel lymph node biopsy(SLNB) were enrolled in this study from January 1,2020 to December 31,2022 in Affiliated Hospital of Inner Mongolia Medical University.Univariate and multivariate logistic regression analysis methods were adopted to analyze the correlation between SLN metastasis and factors of lymphoscintigraphy and clinicopathological characteristics.Three dimensional(3D) fusion reconstruction technology was used to reconstruct skin and bones for patients with positive lymphatic imaging and then SLN was positioned with axillary body surface marking and intercostal spaces.Results SLN metastasis was occurred in 59 patients(20.49%).Univariate analysis showed that age(χ^(2)=4.318,P=0.038),menstrual status(χ^(2)=8.090,P=0.004),and the number of SLNs on the SPECT/CT images(χ^(2)=5.631,P=0.018) were associated with SLN metastasis.Multivariate analysis showed that the number of SLNs on the SPECT/CT images(OR=2.387,95%CI:1.137-5.013,P=0.022) had diagnostic value for SLN metastasis.When the number of SLNs on the SPECT/CT images was ≤1,the SLNs metastasis rate was 24.14%(49/203).When the number of SLNs on the SPECT/CT images was > 1,the SLNs metastasis rate was 11.76%(10/85).The sensitivity and specificity of SPECT/CT lymphoscintigraphy in diagnosing SLN metastasis were 83.05%(49/59)and 32.75%(75/229),respectively.Among 204 patients with positive results of lymphoscintigraphy,the " hottest" SLN was mostly distributed near the midaxillary line,followed by the anterior axillary line and posterior axillary line.The " hottest" SLN was most distributed in the second rib gap,followed by the first rib gap,third rib gap,fourth rib gap,and fifth rib gap

关 键 词：锝 核素 SPECT/CT 淋巴显像 前哨淋巴结活检 

分 类 号：R737.9[医药卫生—肿瘤]