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目的:探索一种准确、实用、经济的口腔鳞癌哨位淋巴结定位方法。方法:选择拟行一侧选择性颈淋巴清扫术的T1/T3N0M0口腔鳞癌患者25例,术前行平面淋巴显像和SPECT/CT融合显像,联合术中蓝染法定位哨位淋巴结,分别比较平面淋巴显像和融合显像的结果,以及哨位淋巴结和颈清标本的病理结果。结果:术前平面淋巴显像的25例患者中,23例显示哨位淋巴结;应用SPECT/CT同机融合显像技术,25例患者均能显示哨位淋巴结(25/25)。融合显像发现,平面显像未能显示的哨位淋巴结7枚,其中1枚存在肿瘤转移。所有出现核素浓聚的淋巴结,均能在融合图像中获得较为准确的解剖定位。哨位淋巴结对颈淋巴结状况预测的敏感度为85.7%,特异度及阳性预测值为100%,阴性预测值为94.7%,准确度为96%。结论:SPECT/CT同机融合显像技术能提供比平面淋巴显像更多的信息,降低了哨位淋巴结活检的假阴性率;是一种较为准确、实用、经济的定位口腔鳞癌哨位淋巴结的新方法。
Objective: To explore an accurate, practical and economical method for the localization of sentinel lymph nodes in oral squamous cell carcinoma. Methods: Twenty-five patients with T1 / T3N0M0 oral squamous cell carcinoma who underwent selective neck dissection were enrolled in this study. Plane lymphoscintigraphy and SPECT / CT fusion imaging were performed preoperatively, and sentinel lymph nodes were identified by blue staining. The results of planar lymphoscintigraphy and fusion imaging, as well as the pathological findings of sentinel lymph nodes and cervical specimens were compared. Results: Of the 25 patients who underwent preoperative planar lymphoscintigraphy, 23 showed sentinel lymph nodes. All 25 patients showed sentinel lymph nodes (25/25) using SPECT / CT fusion imaging. Fusion imaging found that flat imaging failed to show the sentinel lymph nodes 7, of which there is a tumor metastasis. All the lymph nodes with nuclide accumulation can obtain more accurate anatomic localization in the fused images. The sensitivity of sentinel lymph nodes to cervical lymph node status prediction was 85.7%, the specificity and positive predictive value was 100%, the negative predictive value was 94.7% and the accuracy was 96%. CONCLUSIONS: SPECT / CT fusion imaging can provide more information than planar lymphoscintigraphy and reduce the false-negative rate of sentinel lymph node biopsy. It is a more accurate, practical and economical method to locate sentinel lymph nodes of oral squamous cell carcinoma new method.