探讨用放射性硫胶体(SC)单光子发射计算机断层显像(SPECT)/CT探测乳腺癌前哨淋巴结(SLN)的应用价值。

按照入组和排除标准，收集2015年4～8月在青岛大学附属医院确诊的118例女性乳腺癌患者临床资料进行回顾性分析。患者术前行⁹⁹Tc^m-SC SPECT/CT联合术中蓝染法定位SLN,以联合法(SPECT/CT＋蓝染法)检出结果为标准，比较单纯平面显像、蓝染法、SPECT/CT 3种方法对SLN的检出率，并对所有检出的SLN送病理检查。组间SLN检出率(以病例数分析)的比较采用Fisher精确概率法，SLN检出率(以淋巴结数分析)的比较及SLN病理阳性率的比较采用配对χ²检验。

以联合法(SPECT/CT＋蓝染法)检出结果为标准，从病例数角度分析，平面显像、SPECT/CT及蓝染法的SLN检出率分别为91.53%(108/118)、97.46%(115/118)和97.46%(115/118)，差异有统计学意义(P＝0.020)，SPECT/CT及蓝染法的SLN检出率高于平面显像(χ²＝5.143、5.143，P＝0.023、0.023)。从淋巴结数的角度分析，平面显像、SPECT/CT及蓝染法的SLN检出率分别为61.72%(158/256)、96.88%(248/256)和95.70%(245/256)，差异有统计学意义(χ²＝158.072，P<0.001)，SPECT/CT与蓝染法的SLN检出率也高于平面显像(χ²＝90.000、87.000，P<0.001)。对于腋窝区SLN，平面显像、SPECT/CT及蓝染法的检出率分别为64.44%(154/239)、96.65%(231/239)和100.00%(239/239)，差异有统计学意义(χ²＝163.312，P<0.001)，SPECT/CT与蓝染法均高于平面显像(χ²＝77.000、85.000，P均<0.001)，蓝染法高于SPECT/CT(χ²＝6.125，P＝0.013)。对于非腋窝区SLN，平面显像、SPECT/CT及蓝染法的检出率分别为4/17、17/17和6/17，差异有统计学意义(χ²＝23.139，P<0.001)，SPECT/CT高于平面显像及蓝染法(χ²＝11.077、9.091，P＝0.001、0.003)。SPECT/CT与蓝染法检出的SLN病理阳性率分别为24.22%(62/256)和21.09%(54/256)，差异无统计学意义(χ²＝3.500，P＝0.061)。对于腋窝区淋巴结，蓝染法比SPECT/CT多发现8枚，其中3枚SPECT/CT阴性的淋巴结经病理证实为淋巴结宏转移，另5枚均为非转移淋巴结。对于非腋窝区淋巴结，SPECT/CT比蓝染法多发现11枚(3枚内乳淋巴结，5枚胸肌间淋巴结，3枚乳腺内淋巴结)，病理证实9枚微转移淋巴结，2枚宏转移淋巴结。

SPECT/CT的应用能够更精确地指导SLN活组织检查定位，而且在提高病理阳性SLN的检出率，尤其是探测非腋窝SLN方面，SPECT/CT较蓝染法有较大优势。

To evaluate the application of SPECT/CT with radioactive sulfur colloid (⁹⁹Tc^m-SC) in detecting sentinel lymph nodes (SLNs) in breast cancer patients.

According to the inclusion and exclusion criteria, a total of 118 breast cancer patients in the Affiliated Hospital of Qingdao University from April 2015 to August 2015 were enrolled in this retrospective study. All patients underwent preoperative ⁹⁹Tc^m-SC SPECT/CT combined with intraoperative blue dye tracing to detect SLNs. With the results of SPECT/CT plus blue dye tracing as the gold standard, the detection rate of SLNs by planar imaging, SPECT/CT or blue dye tracing alone was compared. All detected SLNs were sent to the pathologic examination. The detection rate of SLNs (based on cases) was compared using Fisher exact probability method, the detection rate of SLNs (based on node number) was compared using paired χ² test, and the detection rate of pathologically positive SLNs by SPECT/CT and blue dye tracing was compared using paired χ² test.

With the results of SPECT/CT plus blue dye tracing as the gold standard, the detection rate of SLNs (based on cases) by planar imaging, SPECT/CT or blue dye tracing alone was 91.53%(108/118), 97.46%(115/118)and 97.46%(115/118) respectively, indicating a significant difference (P=0.020), and the detection rate by SPECT/CT or blue dye tracing was significantly higher than that by planar imaging(χ²=5.143, 5.143; P=0.023, 0.023). The detection rate of SLNs (based on node number) by planar imaging, SPECT/CT and blue dye tracing was 61.72% (158/256), 96.88% (248/256) and 95.70% (245/256) respectively, indicating a significant difference (χ²=158.072, P<0.001). The detection rates by SPECT/CT and blue dye tracing was significantly higher than that by plane imaging (χ²=90.000, 87.000; both P<0.001). The detection rate of SLNs in axillary region by planar imaging, SPECT/CT and blue dye tracing was 64.44% (154/239), 96.65% (231/239) and 100.00% (239/239) respectively, indicating a significant difference (χ²=163.312, P<0.001). The detection rate of SLNs in axillary region by SPECT/CT and blue dye tracing was significantly higher than that by planar imaging(χ²=77.000, 85.000; both P<0.001), while the detection rate of SLNs in axillary region by blue dye tracing was significantly higher than that by by SPECT/CT (χ²=6.125, P=0.013). The detection rate of SLNs in non-axillary region by planar imaging, SPECT/CT and blue dye tracing was 4/17, 17/17 and 6/17 respectively, indicating a significant difference(χ²=23.139, P<0.001). The detection rate of SLNs in non-axillary region by SPECT/CT was significantly higher than that by planar imaging and blue dye tracing (χ²=11.077, 9.091; P=0.001, 0.003). The pathologically positive rate of SLNs detected by SPECT/CT and blue dye tracing was 24.22% (62/256) and 21.09% (54/256) respectively, indicating no significant difference (χ²= 3.500, P = 0.061). For axillary lymph nodes, eight SLNs which were not detected by SPECT/CT were found by blue dye tracing, including 3 with macrometastasis and 5 without metastasis in the pathological examination. For non-axillary lymph nodes, 11 SLNs (3 internal mammary nodes, 5 interpectoral lymph nodes, 3 intramammary nodes) which were not detected by blue dye tracing were found by SPECT/CT, including 9 with micrometastasis and 2 with macrometastasis in pathological examination.

SPECT/CT can provide guidance for accurate detection of SLNs and precise positioning of SLN biopsy. Furthermore, it can improve the detection rate of pathologically positive SLNs, especially for non-axillary SLNs, superior to blue dye tracing.