SPECT/CT在阴茎阴囊肿瘤淋巴显影中的初步临床应用

摘要

Background and purpose: The status of regional lymph nodes is the main prognostic factor for the survival of patients with penoscrotal carcinoma.Recently, studies have focused on dynamic sentinel node biopsy (DSNB).This is an important field in penile cancer.We have developed lymphoscintigraphy with SPECT/CT and DSNB in penoscrotal carcinoma.This study aimed to evaluate the clinical benefit of SPECT/CT fusion imaging in penoscrotal carcinoma.Methods: Seven cases of penile or scrotum carcinoma underwent lymphoscintigraphy with SPECT/CT in our institution.The clinical data and lymphoscintigraphy images of these patients were collected and analyzed; and also reviewed the literature.Results: Lymphatic drainage was observed in 6 of the 7 patients, leading to a visualization rate of 85.7％.Compared to the planer image, the fusion image could show more sentinel lymph nodes in patients without previous treatment.The technique also found altered lymph node drainages in patients who had had inguinal lymphadenectomy.Conclusion: SPECT/CT fusion images can anatomically map the lymphatic drainage of penile and scrotum carcinoma.The technique improved the success rate of DSNB in untreated patients.Furthermore,SPECT/CT fusion images may be helpful for the evaluation of lymph node status of the patients who already have inguinal lymphadenectomy during follow-up.%背景与目的:阴茎阴囊癌区域淋巴结转移情况是疾病预后的重要影响因素.近年来,国外对阴茎癌的研究重点集中在动态前哨淋巴结活检术.我院已经在阴茎阴囊癌患者中逐步开展SPECT/CT淋巴显影和动态前哨淋巴结活检术,现初步评价SPECT/CT在阴茎阴囊肿瘤淋巴显影中的临床应用价值.方法:通过多功能ECT对阴茎阴囊癌患者进行术前同机融合淋巴显影,分析我院7例行SPECT/CT淋巴显影的患者资料,并结合文献复习进行讨论.结果:7例患者中6例可见淋巴结显影.相比于平面显影,SPECT/CT能更精确的定位阴茎阴囊癌区域淋巴引流,不仅能检出平面显影不易或不能发现的淋巴结(7例患者中多发现3枚),同时还可以发现异位的淋巴引流.结论:SPECT/CT能够精确的定位阴茎阴囊肿瘤的引流淋巴结.对初诊的患者,可行SPECT/CT淋巴显影提高前哨淋巴结活检的成功率;对已行腹股沟淋巴结清扫的患者,可通过SPECT/CT淋巴显影的资料有针对性的进行淋巴结评估和随访.