Positron emission tomography in combination with sentinel node biopsy reduces the rate of elective neck dissections in the treatment of oral and oropharyngeal cancer.
Positron emission tomography in combination with sentinel node biopsy reduces the rate of elective neck dissections in the treatment of oral and oropharyngeal cancer.
复制标题
正电子发射断层扫描与前哨淋巴结活检相结合可降低口腔癌和口咽癌治疗中选择性颈清扫术的发生率。
DOI：
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发表时间：
2004
影响因子：
45.3
通讯作者：
K. Bitter
中科院分区：
文献类型：
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作者：
A. Kovács;N. Döbert;J. Gaa;C. Menzel;K. Bitter
目的
旨在评估包括 [(18)F] 氟脱氧葡萄糖正电子发射断层扫描 (PET) 和淋巴闪烁显像引导的前哨淋巴结活检 (LS/SNB) 在内的诊断阶梯对口腔和口咽鳞状细胞癌 (OOSCC) 患者颈部治疗的影响。
患者和方法
前瞻性地，62 名可切除 T1-3 OOSCC 患者接受了计算机断层扫描 (CT) 和 PET。 PET 中没有颈部摄取的患者被定义为 cN0，并计入 LS/SNB。结果与组织病理学相关。根据 CT 结果得出的传统指南与实际治疗方案和结果进行了比较。
结果
PET 与 CT 的敏感性、特异性、有效性以及阳性和阴性预测值分别为 72% vs 89%、82% vs 77%、79% vs 80.5%、62% vs 61.5% 和 88% vs 94.5%（不显着）。 38 名 PET 阴性患者接受了 LS/SNB。所有 38 名患者均发现前哨淋巴结。 5 名患者出现淋巴结阳性（PET 假阴性）并接受了颈清扫术 (ND)。根据指南，36 名 CT 阴性患者中的 51 名颈侧将接受选择性 ND 治疗，并且至少 45 名颈侧因 CT 结果呈阳性而必须接受广泛 ND（124 名颈侧中的 96 名）。相比之下，PET 结合 LS/SNB 则保留了 59 个颈侧，并且由于 PET 分期、LS/SNB 和术中决策，124 个颈侧中的 41 个实际上接受了 ND。中位随访 35 个月后，两名患者（cN+ve 和 pN+ve）出现颈部复发。
结论
与无局部危险的 CT 相比，使用 PET 结合 LS/SNB 进行诊断大大减少了 OOSCC 中广泛 ND 的数量。
PURPOSE
To assess the impact of a diagnostic ladder including [(18)F]fluorodeoxyglucose positron emission tomography (PET) and lymphoscintigraphy guided sentinel node biopsy (LS/SNB) on neck treatment in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC).
PATIENTS AND METHODS
Prospectively, 62 patients with resectable T1-3 OOSCC underwent computed tomography (CT) and PET. Patients without neck uptake in PET were defined as cN0 and were accrued for LS/SNB. Results were correlated with histopathology. The traditional guidelines according to CT findings were compared to the actual regimen and the outcome.
RESULTS
Sensitivity, specificity, validity, and positive and negative predictive value of PET versus CT were 72% v 89%, 82% v 77%, 79% v 80.5%, 62% v 61.5%, and 88% v 94.5% (not significant). Thirty-eight PET negative patients underwent LS/SNB. Sentinel lymph nodes were found in all 38 patients. Five patients had positive nodes (PET false-negatives) and underwent neck dissection (ND). Fifty-one neck sides in 36 patients who were CT-negative would have been treated with selective ND according to the guidelines, and at least 45 neck sides would have had to undergo extensive ND because of positive CT findings (96 of 124 neck sides). In contrast, PET in combination with LS/SNB spared 59 neck sides, and 41 of 124 neck sides actually underwent ND as a result of PET staging, LS/SNB, and intraoperative decision. After a median follow-up of 35 months, two patients (both cN+ve and pN+ve) suffered from neck relapses.
CONCLUSION
Diagnostics using PET in combination with LS/SNB considerably reduced the number of extensive ND in OOSCC as compared to CT without locoregional hazard.