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摘要:
目的 前哨淋巴结显像及活检是皮肤肿瘤诊治的重要环节, 本研究探讨SPECT/CT在定位诊断皮肤肿瘤前哨淋巴结中的作用。 方法 回顾性总结2019年4月-2023年2月北京协和医院皮肤科病理活检明确诊断为皮肤恶性肿瘤且行前哨淋巴结显像的患者临床资料, 分析其前哨淋巴结显像结果以及前哨淋巴结显像中SPECT/CT的作用。 结果 共37例皮肤肿瘤患者纳入本研究, 其中恶性黑色素瘤患者32例, 皮肤鳞状细胞癌患者3例, 基底细胞癌患者2例; 前哨淋巴结定位于腹股沟23例、腘窝2例、腋窝8例、滑车2例、腮腺/耳前2例。共36例行SPECT/CT显像(1例仅行平面动态显像)。16例患者于同侧淋巴引流途径见多处局灶性浓聚灶, 平面动态显像或SPECT显像难以明确前哨淋巴结定位, SPECT/CT判定其中13例患者为局部淋巴管内示踪剂一过性滞留(即假阳性摄取), 并明确了前哨淋巴结定位。34例患者在前哨淋巴结显像后1~4 h即行活检术, 术中γ探测仪引导下定位的前哨淋巴结部位与前哨淋巴结显像结果均一致; 6例患者前哨淋巴结有转移, 且均为足部及下肢的恶性黑色素瘤。 结论 前哨淋巴结显像是前哨淋巴结活检术前重要的定位方法, SPECT/CT有助于提高前哨淋巴结显像定位准确性。 Abstract:Objective Sentinel node lymphoscintigraphy and biopsy is an essential procedure in theranostics of skin tumors.The aim of this study is to determine the role of SPECT/CT in localization of sentinel lymph node of skin tumors. Methods This study retrospectively reviewed the sentinel node lymphoscintigraphy and biopsy data in patients with skin tumors diagnosed in Peking Union Medical College Hospital from April 2019 to February 2023, and analyzed the role of SPECT/CT in sentinel lymphoscintigraphy. Results Thirty-seven patients were retrospectively enrolled.The primary skin tumor included melanoma (32 patients), squamous cell carcinoma (3 patients), and basal cell carcinoma (2 patients).The sentinel nodes localized in inguinal (23 patients), popliteal (2 patients), axilla (8 patients), trochlea (2 patients), and parotid/periauricular regions (2 patients).Sentinel lymph nodes were localized by SPECT/CT in 36 cases (one patient only underwent planar dynamic imaging).SPECT/CT detected multiple focus in the lymphatic drainage in 16 patients, and in 13 patients they were confirmed to be local retention of the tracer in the lymphatic duct instead of the sentinel lymph node, suggesting false positive uptake.Thirty-four patients underwent sentinel node biopsy 1-4 h after localization, and localization of the sentinel node was consistent with preoperative sentinel node lymphoscintigraphy.Sentinel node biopsy found nodal metastasis in 6 patients (all of them had melanoma in the foot or lower limb). Conclusions Sentinel node lymphoscintigraphy is an important step for localization before sentinel node biopsy.SPECT/CT can help improve the accuracy of localizing sentinel lymph node. -
Key words:
- skin tumor /
- sentinel lymph node /
- SPECT/CT /
- diagnosis /
- treatment
作者贡献：朱世坤负责研究设计、数据采集及论文初稿撰写；张舒负责临床数据收集；罗亚平负责研究设计指导与论文修订。利益冲突：所有作者均声明不存在利益冲突 -
图 1 1例右足底恶性黑色素瘤患者(男性，55岁，T1N0M0)前哨淋巴结SPECT/CT显像图(箭头)
A.SPECT/CT融合投影图可见右侧腘窝、大腿及腹股沟区多处局灶性浓聚灶; B~E.SPECT/CT矢状面断层图像见右侧腘窝及大腿处浓聚灶定位于淋巴管，考虑为示踪剂在淋巴管内一过性滞留所致；F~G.SPECT/CT横断层图像见右侧腹股沟区浓聚灶定位于腹股沟一枚淋巴结，考虑为前哨淋巴结，后术中γ探测仪证实右侧腹股沟淋巴结为前哨淋巴结，淋巴结活检病理未见转移
图 2 1例左手背高分化鳞状细胞癌患者(男性，37岁)前哨淋巴结SPECT/CT显像图(箭头)
A.SPECT/CT融合投影图可见左手背瘤周注射点，左侧滑车、腋窝多处局灶性浓聚灶; B~C.SPECT/CT横断层图像见左侧滑车浓聚灶; D~E.SPECT/CT横断层图像见左侧腋窝浓聚灶均定位于淋巴结，因此考虑左侧滑车淋巴结为前哨淋巴结，左侧腋窝淋巴结为次级淋巴结, 后术中γ探测仪引导下行左侧滑车前哨淋巴结活检，病理未见转移
表 1 37例皮肤肿瘤患者一般临床资料
指标 数值 年龄(x±s，岁) 58.7±14.2 性别[n(%)] 男 20(54.1) 女 17(45.9) 病程[M(P25, P75)，月] 48(12, 120) 皮肤肿瘤部位[n(%)] 肢端(手、足、甲下) 24(64.9) 四肢 7(18.9) 躯干 2(5.4) 头颈部 2(5.4) 外阴 2(5.4) 病理类型[n(%)] 黑色素瘤 32(86.5) 鳞状细胞癌 3(8.1) 基底细胞癌 2(5.4) Breslow深度[M(P25, P75)，mm]* 3.5(1.5，5.9) 肿瘤病理分期[n(%)] Ⅰ~Ⅱ期 31(83.8) Ⅲ期 6 (16.2) *8例患者缺乏相应资料 
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表 2 37例皮肤肿瘤患者前哨淋巴结显像结果
肿瘤部位 前哨淋巴结
部位例数
(n)前哨淋巴结活检结果 足部及下肢 腹股沟 21 4例转移，16例阴性，1例未行活检 腘窝 2 2例转移 手部及上肢 腋窝 6 5例阴性，1例未行活检 滑车 2 均为阴性 躯干 腋窝 2 1例阴性，1例未行活检 头颈部 腮腺/耳前 2 均为阴性 外阴 腹股沟 2 均为阴性
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表 3 16例经SPECT/CT明确定位的前哨淋巴结分布情况
平面/SPECT显像
显影部位SPECT/CT
定位的前哨
淋巴结例数
(n)术中定位的前哨淋巴结 腘窝、大腿、腹股沟 腹股沟 12 腹股沟11例，1例未行活检 腘窝、腹股沟 腘窝 2 腘窝 前臂、肘部、腋窝 腋窝 1 腋窝 肘部、腋窝 滑车 1 滑车
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