Radioguided detection of lymph node metastasis in non-small cell lung cancer
Radioguided detection of lymph node metastasis in non-small cell lung cancer
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DOI：
10.1016/j.athoracsur.2006.05.104
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发表时间：
2006-11-01
影响因子：
4.6
通讯作者：
Demmy, Todd
中科院分区：
文献类型：
--
作者：
Nwogu, Chumy;Fischer, Gabor;Demmy, Todd
背景胸部淋巴结微转移的检测可能有助于提高非小细胞肺癌患者的分期。10例可切除的肺癌患者入组本初步研究。术前均行正电子发射断层扫描（PET）和纵隔镜检查。在手术当天，在计划的手术程序的4小时内，对患者注射10 mCi的F18-氟脱氧葡萄糖（FDG）。在肺切除术过程中，手持设备检测到胸部淋巴结内FDG摄取（γ发射）增加。对常规苏木精-伊红染色显示FDG摄取增加但非恶性的淋巴结进行连续切片和免疫组化染色。手持式探头在PET成像上检测到所有FDG-亲合病变。在3例患者（30%）中，探头导致检测到常规病理分析遗漏的FDG-亲合性淋巴结微转移。第四名患者的淋巴结在PET上呈FDG-亲合性，并通过苏木精和伊红染色显示转移，但探针检测到同一站点的相邻淋巴结有微转移。3个淋巴结在伽玛刀检查中呈假阳性。通过使用FDG敏感的术中伽马探针检测淋巴结中的隐匿性转移是可行的，从而提高患者的分期。需要进行更大规模的研究，以评价此类器械的灵敏度、特异性和临床实用性。
Background. The detection of micrometastases in thoracic lymph nodes may improve the staging of non-small cell lung cancer patients.Methods. Ten patients with resectable lung cancers were enrolled in this pilot study. Every patient had preoperative positron emission tomography ( PET) imaging and mediastinoscopy. Patients were injected with 10 mCi of F18-fluorodeoxyglucose ( FDG) on the day of surgery, within 4 hours of the planned surgical procedure. A handheld device detected increased FDG uptake ( gamma emission) within thoracic lymph nodes during pulmonary resection procedures. The lymph nodes that demonstrated increased FDG uptake, but were nonmalignant by conventional hematoxylin and eosin staining, underwent further serial sectioning and immunohistochemical staining.Results. The handheld probe detected all FDG-avid lesions on PET imaging. In 3 patients ( 30%), the probe led to the detection of FDG-avid lymph nodes harboring micrometastases missed by conventional pathologic analysis. A fourth patient had aortopulmonary nodes that were FDG-avid on PET and showed metastases by hematoxylin and eosin staining, but the probe detected adjacent nodes in the same station with micrometastases. Three nodes were false-positive by gamma probe.Conclusions. It is feasible to detect occult metastases in lymph nodes by using an FDG-sensitive intraoperative gamma probe, resulting in upstaging of patients. A larger study is indicated to evaluate the sensitivity, specificity, and clinical utility of such a device.