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^99mTc-SPECT/CT Combined with Carbon Nanoparticles Suspension Injection for Sentinel Lymph Node Mapping in Patients with Gastrointestinal Cancer Cancer

Author: WangYaZuo
Tutor: LiGuoXin
School: Southern Medical University,
Course: Surgery
Keywords: SPECT / CT Carbon nanoparticles suspension injection Sentinel lymph node Cancer Gastric cancer
CLC: R735
Type: Master's thesis
Year: 2011
Downloads: 40
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Abstract

Background sentinel lymph node is the first to accept the area of ??primary tumor-draining lymph nodes, but also the transfer of the first place, can be used to predict malignant regional lymph node metastasis. Sentinel lymph node navigation surgery (SNNS) is the first to be used in breast cancer and melanoma patients with lymph node dissection to evaluate the range, has also recently been used in gastrointestinal cancer surgery. From sentinel lymph node navigation technology used in colorectal cancer, Miwa K in 2000 the first report of the sentinel lymph node navigation technology used in gastric cancer surgery since 1997, Saha was first reported, many research reports confirm the sentinel lymph node of gastrointestinal cancer region lymph node metastasis predictive accuracy rate ranging between 58% and 100%, with encouraging results. The sentinel lymph node in gastrointestinal cancer surgery early experience with the use of navigation technology that the technology may bring new inspiration to us in the surgical approach and adjuvant treatment options. The selection of the surgical approach, with the popularity of gastroscopy examination, the detection rate of early gastrointestinal cancer increased year by year, will enable us to more accurate preoperative and intraoperative sentinel lymph node biopsy of regional lymph node metastasis prediction in gastrointestinal cancer staging, individualized surgical treatment for early gastrointestinal cancer, submucosal resection, local excision or gastrointestinal partial, rather than waking traditional gastrointestinal cancer radical surgery, which ensure the operation oncology effect at the same time, improve the patient's quality of life after. Known, regional lymph node metastasis has important guiding significance for the treatment of gastrointestinal cancer patients, however, commonly used pathology detection method is still traditional hematoxylin and eosin (HE) staining method, this method for the detection lymph node metastasis, high false negative rate, particularly reflected especially in the early gastrointestinal cancer patients with regional lymph node micrometastases detected. However IHC or PCR testing for all regional lymph node dissection is not only time-consuming and expensive, and difficult to promote a limited number of sentinel lymph node carefully IHC or PCR assay to predict clinical regional lymph node metastasis in clinical feasible, and can get more accurate pathological staging leaving doctors to develop more accurate postoperative treatment program for patients. Although gastrointestinal cancer sentinel lymph node navigation surgery may play a larger role in guiding individualized treatment for early gastrointestinal cancer patients, but its application is still in dispute, did not carry out extensive clinical. The reason is mainly because of the the gastrointestinal lymphatic drainage around the existence of a complex multi-directional network, and transfer of the high incidence of lymph node jump, so that some patients in the sentinel lymph node observation difficult, difficult to define precisely the sentinel lymph node. Clinical sentinel lymph node tracing method many common, there are two: one for the simple visual method, intraoperative visual inspection after the injection of dye around the tumor mucosa or serosa stained lymphatic first stained lymph nodes is defined as the sentinel lymph node. This method is convenient and easy, does not require special equipment, but its drawback is that the majority of the dye in the lymphatic vessels and lymph metabolism faster, combined, about 1-4% of patients with sentinel lymph node in our conventional lymphadenectomy beyond especially stomach mesenteric fat more patients, there are many visual blind spot, unable to do a comprehensive observation and precise definition of the sentinel lymph node. Simply use dyes visual method of sentinel lymph node tracing success rate is not high, the stability of the SLN navigation is not ideal. In order to compensate for the errors in the visual, in recent years, most scholars have adopted the method of combining radionuclide detection and dye, the day before surgery submucosal injection of radionuclides around the tumor, intraoperative injection of dye, in addition to the observed dye staining first extranodal also use the the γ detectors individually scan at the surgery Lieutenant regional lymph nodes, the lymph nodes filter out more than 10 times higher than the background radiation value be defined as the sentinel lymph node. This method makes more accurate definition of the sentinel lymph node volatility than a simple visual method significantly reduced, and improved stability. This method requires specialized intraoperative gamma probe region by region, and the need to stereotype isolated after exploration, more cumbersome to operate significantly longer operative time, these factors limit its clinical use. Recently, scholars using single photon emission computed tomography and CT (SPECT / CT) imaging technology combined with sentinel lymph node and its surrounding anatomical structures, three-dimensional rendering, further improve the success rate and accuracy of preoperative sentinel lymph node mapping The initial attempt to breast cancer, prostate cancer, melanoma, gynecologic oncology and head and neck cancer exciting effect. This study attempts to 99mTc-SPECT/CT nano carbon dye method, preliminary evaluation of this new method of tracing the technical feasibility and clinical value of gastrointestinal cancer sentinel lymph node. The purpose of a preliminary evaluation of the use of single-photon emission computed tomography / Integrated CT (SPECT / CT) combined with the value of the clinical use of carbon nanoparticles suspension injection early gastrointestinal cancer sentinel lymph node tracing. Method from January 2010 to December 2010, a total of 12 patients with rectal cancer and six cases of gastric cancer patients included in the study, all patients with clinical stage for cT1 2N0M0. 1 day before surgery by gastroscopy or colonoscopy cancer around submucosal injection 1ml carbon nanoparticles suspension injection 1ml 99m technetium-labeled sulfur colloid (99mTc-Sc) mixture after tracer injection 1,3, 5 hours underwent SPECT / CT scan, clear sentinel lymph node number and analysis of the sentinel lymph node area. Postoperative preoperative SPECT / CT sentinel lymph node area lymph radioactivity measurements, take a the radioactive count value highest or several lymph nodes identified as sentinel lymph node (the number has been preoperative SPECT / CT determined). All of the sentinel lymph node and non-sentinel lymph node immunohistochemical pathology detection. Results 1,12 patients with rectal cancer sentinel lymph node tracer success rate was 91.7% (11/12). The tracer 11 patients in each patient at least one sentinel lymph nodes (1-3 pieces). Pathological examination of sentinel lymph node in 10 patients, and other regional lymph nodes showed no metastasis, sentinel lymph node in patients and other regional lymph nodes are visible cancer metastasis, sentinel lymph node regional lymph node metastasis prediction accuracy rate of 100%. 2,6 patients with gastric cancer sentinel lymph node tracing success rate of 100% (6/6). Patients in each patient at least one sentinel lymph nodes (1-2 pieces). Six cases of sentinel lymph nodes in patients with regional lymph node CK immunohistochemistry were negative, accurate prediction of regional lymph node sentinel lymph node was 100%. Anatomical location and number of conclusions of SPECT / CT combined with carbon nanoparticles suspension injection can effectively determine early gastrointestinal cancer patients with sentinel lymph node accurately predict regional lymph node status, and worthy of further study.

99mTc-SPECT/CT Combined with Carbon Nanoparticles Suspension Injection for Sentinel Lymph Node Mapping in Patients with Gastrointestinal Cancer Cancer

Abstract

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^99mTc-SPECT/CT Combined with Carbon Nanoparticles Suspension Injection for Sentinel Lymph Node Mapping in Patients with Gastrointestinal Cancer Cancer