| Objective To evaluate PET/CT combined with SPECT/CT in the detection of sentinel lymph node (SLN) in patients with cNo laryngeal squamous cell carcinoma (LSCC).Methods Fifteen patients with cN0 LSCC were eligible for the study. With preoperative 18F-fluoro-deoxy-glucose (18F-FDG) PET/CT imaging conducted in parallet, the lymphoscintigraphy was performed with radioactivity isotope 99Tcm-sulfer colloid (99Tcm-SC), and the SLN was qualitative and positioned by the combination of the two ways. The SLN was determined using a handheld gamma detection probe during the operation. The surgical removal of the SLNs and non-sentinel lymph nodes were examined by rapid pathological examination during operation.Results Suspected lymph node was detected with preoperative PET/CT imaging and SLN was detected with SPECT/CT imaging in fifteen patients with LSCC, two cases were not developed by the both of the two ways, hence a detection rate was 86.7%. In the thirteen cases,13 suspected lymph nodes were detected by the PET/CT imaging, and 23 SLNs were detected by the preoperative SPECT/CT imaging, of which 13 suspected lymph nodes were consistent with the SLNs by CT positioning.22 SLNs were detected in 13 cases by intraoperative gamma probe; the results from gamma probe were the same with the results from preoperative lymphograhy in 12 out of 13 cases and different in 1 case, which implies acorrelative rate of 92.3%. The number of surgical resection of SLNs and NSLNs were 23 and 44 respectively. Six patients, accounting for 40%, were pathologically confirmed with lymph node metastasis, based on which, the transfer degree of SLN was 21.7%(5/23) higher than NSLN transfer degree the 2.3%(1/44) (P=0.008). The SUNmean of the six cases with lymph node metastasis was 3.51±1.76, higher than the nine cases that without lymph node metastasis whose SUNmean was 1.58±0.64(P=0.010). The sensitivity of SLN detection was 83.3%, the accuracy 86.7% and the false negative rate was 16.7%.Conclusion The preoperative PET/CT combined with SPECT/CT can improve the qualitative and positioning assessment of the SLN micrometastases in patients with cNo stage LSCC, which will help to select the reasonableness of surgical programs. Intraoperative SLN detection instrument combining gamma probe and SUV values help to increase accuracy of the reference range of neck dissection. |
PDF Full Text Request