Noninvasive detection of clinically occult lymph-node metastases in prostate cancer
Noninvasive detection of clinically occult lymph-node metastases in prostate cancer
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DOI：
10.1056/nejmoa022749
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发表时间：
2003-06-19
影响因子：
158.5
通讯作者：
Weissleder, R
中科院分区：
文献类型：
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作者：
Harisinghani, MG;Barentsz, J;Weissleder, R
背景：准确检测前列腺癌的淋巴结转移是治疗方法的一个重要组成部分。我们研究了通过间质 - 淋巴液运输进入淋巴结的高度亲淋巴超顺磁性纳米粒子是否可与高分辨率磁共振成像（MRI）联合使用，以显示小的淋巴结转移灶。
方法：招募了80例术前临床分期为T1、T2或T3的前列腺癌患者，他们接受了手术淋巴结切除或活检。所有患者在静脉注射亲淋巴超顺磁性纳米粒子（每千克体重2.6毫克铁）之前和24小时后均接受MRI检查。成像结果与组织病理学结果相关联。
结果：在接受切除或活检的334个淋巴结中，33例患者（41%）的63个（18.9%）淋巴结经组织病理学检测有转移。在这63个淋巴结中，45个（71.4%）不符合通常的恶性肿瘤成像标准。使用亲淋巴超顺磁性纳米粒子的MRI正确识别出所有有淋巴结转移的患者，并且逐个淋巴结分析显示其敏感性显著高于常规MRI（90.5%对35.4%，P<0.001）。假阳性率为15.3%（28个淋巴结），假阴性率为9.5%（6个淋巴结）。在有淋巴结转移的患者中，纳米粒子增强MRI检测到的转移淋巴结数量平均比常规MRI多（平均每个患者为3.4个对2.1个，P = 0.002）。
结论：使用亲淋巴超顺磁性纳米粒子的MRI是一种高度敏感的检测前列腺癌淋巴结转移的方法，能够检测出常规成像技术无法发现的小转移灶。这种技术可能有助于改善前列腺癌患者的分期和治疗决策。
BACKGROUND:Accurate detection of lymph-node metastases in prostate cancer is an essential component of the approach to treatment. We investigated whether highly lymphotropic superparamagnetic nanoparticles, which gain access to lymph nodes by means of interstitial-lymphatic fluid transport, could be used in conjunction with high-resolution magnetic resonance imaging (MRI) to reveal small nodal metastases.METHODS:Eighty patients with presurgical clinical stage T1, T2, or T3 prostate cancer who underwent surgical lymph-node resection or biopsy were enrolled. All patients were examined by MRI before and 24 hours after the intravenous administration of lymphotropic superparamagnetic nanoparticles (2.6 mg of iron per kilogram of body weight). The imaging results were correlated with histopathological findings.RESULTS:Of the 334 lymph nodes that underwent resection or biopsy, 63 (18.9 percent) from 33 patients (41 percent) had histopathologically detected metastases. Of these 63 nodes, 45 (71.4 percent) did not fulfill the usual imaging criteria for malignancy. MRI with lymphotropic superparamagnetic nanoparticles correctly identified all patients with nodal metastases, and a node-by-node analysis had a significantly higher sensitivity than conventional MRI (90.5 percent vs. 35.4 percent, P