Fusion of Freehand SPECT and Ultrasound to Perform Ultrasound-Guided Fine-Needle Aspiration Cytology of Sentinel Nodes in Head and Neck Cancer
Fusion of Freehand SPECT and Ultrasound to Perform Ultrasound-Guided Fine-Needle Aspiration Cytology of Sentinel Nodes in Head and Neck Cancer
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DOI：
10.3174/ajnr.a4426
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发表时间：
2015-11-01
影响因子：
3.5
通讯作者：
Castelijns, J. A.
中科院分区：
文献类型：
--
作者：
de Bree, R.;Pouw, B.;Castelijns, J. A.
背景与目的：超声引导下细针穿刺细胞学（USgFNAC）检测临床阴性头颈癌患者隐匿淋巴结转移的标准是基于颈部淋巴结的形态。为了提高USgFNAC的淋巴结选择，我们研究了早期口腔和头颈部皮肤癌患者前哨淋巴结融合单光子发射断层扫描超声引导细针细胞学（freehand SPECT-USgFNAC）的可行性。材料和方法：6例早期头颈癌（4例口腔癌和2例头颈皮肤癌）和临床阴性颈部患者，计划经口或局部切除和前哨淋巴结手术，术前进行了USgFNAC和徒手SPECT-USgFNAC。结果：所有徒手SPECT超声检查在识别前哨淋巴结方面技术上都是成功的。徒手SPECT-USgFNAC所获得的前哨淋巴结抽吸物均含有大量放射性，证实前哨淋巴结穿刺。USgFNAC评估13个淋巴结；手绘SPECT-USgFNAC， 19个节点；前哨淋巴结活检，13个淋巴结。三个前哨淋巴结组织病理呈阳性，选择徒手SPECT-USgFNAC进行吸痰细胞学检查，但常规超声不进行吸痰细胞学检查。细胞学检查结果为阴性或不确定。结论：手绘SPECT超声可以识别前哨淋巴结，并可能通过更好地选择转移风险最高的淋巴结（前哨淋巴结）来改善头颈部癌患者的USgFNAC，但其敏感性受到采样误差和细胞学抽吸材料不足的限制。
BACKGROUND AND PURPOSE: Criteria for ultrasound-guided fine-needle aspiration cytology (USgFNAC) for the detection of occult lymph node metastasis in patients with clinically negative head and neck cancer are based on the morphology of cervical lymph nodes. To improve the selection of lymph nodes for USgFNAC, we examined the feasibility of fused freehand single-photon emission tomography ultrasound-guided fine-needle cytology (freehand SPECT-USgFNAC) of sentinel nodes in patients with early stage oral and head and neck skin cancer.MATERIALS AND METHODS: Six patients with early-stage head and neck cancer (4 oral and 2 head and neck skin cancers) and a clinically negative neck who were scheduled for transoral or local excision and a sentinel node procedure underwent USgFNAC and freehand SPECT-USgFNAC preoperatively.RESULTS: All freehand SPECT sonographic examinations were technically successful in terms of identifying sentinel nodes. All aspirates of sentinel nodes obtained by freehand SPECT-USgFNAC contained substantial radioactivity, confirming puncture of the sentinel nodes. USgFNAC evaluated 13 lymph nodes; freehand SPECT-USgFNAC, 19 nodes; and sentinel node biopsy, 13 nodes. Three sentinel nodes were histopathologically positive and were selected for aspiration cytology by freehand SPECT-USgFNAC, but not by conventional ultrasound. The cytologic examination findings of the aspirations were negative or inconclusive.CONCLUSIONS: Freehand SPECT ultrasound can identify sentinel nodes and could potentially improve USgFNAC in patients with head and neck cancer by better selection of lymph nodes at highest risk of having metastases (sentinel nodes), but its sensitivity is limited by sampling error and insufficient aspirated material for cytology.