Preoperative sentinel lymph node mapping of the prostate using PET/CT fusion imaging and Ga-68-labeled tilmanocept in an animal model
Preoperative sentinel lymph node mapping of the prostate using PET/CT fusion imaging and Ga-68-labeled tilmanocept in an animal model
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DOI：
10.1007/s10585-012-9498-9
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发表时间：
2012-10-01
影响因子：
4
通讯作者：
Vera, David R.
中科院分区：
文献类型：
--
作者：
Stroup, Sean P.;Kane, Christopher J.;Vera, David R.
前哨淋巴结（SLN）的识别与术前图像引导，可以提高前列腺癌的病理分期，通过识别淋巴结的标准模板以外的解剖。四只麻醉的雄性狗接受前列腺内注射Ga-68标记的替马诺塞。每20分钟使用PET/CT融合成像对盆腔淋巴结进行成像。在注射后90分钟，完成直肠切除术和扩大淋巴结切除术;使用手持式伽马检测器记录每个淋巴结的离体放射性，并通过Ga-68放射性测定计算注射剂量的比值（%ID）进行确认。SLN定义为包含最大%ID的> 10%。术前PET/CT融合成像确定每只动物平均4.25个淋巴结（范围3-7）;每只动物的SLN平均数量为4.00个（范围2-6）。切除的SLN中，29%位于标准髂外肌和闭孔肌分布。SLN %ID范围为0.07 - 2.40%（平均值0.744%+/- A 0.641%）; SLN离体计数率范围为88 - 2，175 cpm（平均896 +/- A 715 cpm）; SLN标准化摄取值（SUV）范围为13 ~ 237（平均79 ± A67），PET-CT显像与SLN活性的一致性高，敏感性为93%。在这项可行性研究中，骨盆SLN在60分钟内达到SUV。PET/CT有效地识别了SLN，具有良好的解剖特异性，通过手持式检测和闪烁计数的放射性与术前成像表现出高度一致性。镓-68标记的替马诺塞对前哨淋巴结具有高度特异性。影像引导下的肿瘤切除术和淋巴结清扫术在泌尿系肿瘤学中的应用前景广阔，值得进一步研究。
Sentinel lymph node (SLN) identification with preoperative image guidance may improve pathological staging of prostate cancer by identifying nodes outside the standard template of dissection. Four anesthetized male dogs received an intra-prostatic injection of Ga-68-labeled tilmanocept. Every 20 min the pelvic lymph nodes were imaged using PET/CT fusion imaging. At 90 min post-injection a prostatectomy and extended lymphadenectomy were completed; ex vivo radioactivity was recorded for each node using a handheld gamma detector, and confirmed by calculation of percent-of-injected dose (%ID) via assay of Ga-68 radioactivity. SLNs were defined as containing > 10 % of the maximum %ID. Preoperative PET/CT fusion imaging identified a mean of 4.25 lymph nodes per animal (range 3-7); the mean number of SLN per animal was 4.00 (range 2-6).Of the excised SLNs, 29 % were located in the standard external iliac and obturator distribution. The SLN %ID ranged from 0.07 to 2.40 % (mean 0.744 % +/- A 0.641 %); SLN ex vivo count rate ranged from 88 to 2,175 cpm (mean 896 +/- A 715 cpm); and the SLN standardize uptake values (SUVs) ranged from 13 to 237 (mean 79 +/- A 67).There was a high concordance of PET-CT imaging to SLN activity, with sensitivity of 93 %. In this feasibility study, pelvic SLNs attained SUVs within 60 min. PET/CT effectively identified SLNs with good anatomic specificity, and radioactivity by hand-held detection and scintillation counts demonstrated high concordance with preoperative imaging. Gallium-68-labaled tilmanocept was highly specific for sentinel nodes. Image-guided tumor resection and lymphadenectomy may become a promising future application in urologic oncology and warrants further investigation.