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Togami S, Tokudome A, Fukuda M, Mizuno M, Yanazume S, Kobayashi H. Validation of single-photon emission computed tomography with computed tomography and lymphoscintigraphy for sentinel lymph node identification in cervical cancer. Int J Gynaecol Obstet 2023; 163:813-817. [PMID: 37332155 DOI: 10.1002/ijgo.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/06/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To compare single-photon emission computed tomography with computed tomography (SPECT/CT) and lymphoscintigraphy (LSG) for the detection of sentinel lymph nodes (SLNs) in patients with early-stage cervical cancer. METHODS This hospital-based, single-center, retrospective study included 128 patients with cervical cancer (aged >18 years) treated between 2014 and 2022. Injection of 99 m Technetium-labeled phytate into the uterine cervix was used to detect pelvic SLNs. SNL identification rates and locations were analyzed for preoperative LSG and SPECT/CT. RESULTS Median age and body mass index of patients were 40 years (range, 20-78 years) and 21.7 kg/m2 (range, 16-40 kg/m2 ), respectively. There was no significant difference in overall identification rates (identification of at least one SLN) of SLNs between SPECT/CT (91%) and LSG (88%). There was no significant difference in bilateral SLN identification rates between SPECT/CT (66%) and LSG (65%). A total of 219 pelvic SLNs (110 right and 109 left hemipelvis) were identified by SPECT/CT; the most frequent locations were the obturator (122 SLNs, 56%) and external iliac (67 SLNs, 30%). CONCLUSION SPECT/CT and LSG showed high SLN identification rates in patients with cervical cancer, and there was no significant difference in overall or bilateral SLN identification rates between the two techniques.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Akio Tokudome
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Mika Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Mika Mizuno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Togami S, Kawamura T, Yanazume S, Kamio M, Kobayashi H. Comparison of lymphoscintigraphy and single photon emission computed tomography with computed tomography (SPECT/CT) for sentinel lymph node detection in endometrial cancer. Int J Gynecol Cancer 2020; 30:626-630. [PMID: 32200352 DOI: 10.1136/ijgc-2019-001154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Endometrial cancer is the most common gynecologic cancer, and lymph node metastasis is one of the most important prognostic factors. Increasing evidence shows that sentinel lymph node (SLN) mapping is an effective alternative to comprehensive lymphadenectomy. Single photon emission CT with computed tomography (SPECT/CT) is associated with a high SLN detection rate. OBJECTIVE To compare the clinical efficacy of SPECT/CT with that of lymphoscintigraphy in detecting SLNs in patients with endometrial cancer. METHODS Between May 2014 and October 2018, 151 patients with endometrial cancer were enrolled in this study at the Department of Obstetrics and Gynecology of the Kagoshima University Hospital. Inclusion criteria were patients with endometrial cancer, older than 18 years, and with pre-operative International Federation of Gynecology and Obstetrics (FIGO) staging of I and II. All patients underwent pre-operative CT, and patients with suspected peritoneal dissemination and lymph node metastasis were excluded from this study. Pelvic SLNs were detected by injection of tecnetium-99m-labeled phytate into the uterine cervix. The number and locations of SLNs detected using lymphoscintigraphy and SPECT/CT were evaluated. JMP software (version 14, SAS Institute Inc., Cary, North Carolina, USA) was used for statistical analysis. RESULTS A total of 151 patients who underwent pre-operative lymphoscintigraphy and SPECT/CT were included in the study. The median age was 57 years (range 24-79), and the median body mass index was 24.3 kg/m2 (range 16-40). The final pathology was as follows: 135 (89%) endometrioid carcinoma, 11 (7%) serous carcinoma, one (1%) clear cell carcinoma, and four (3%) other histotypes. Based on SPECT/CT, 204 pelvic SLNs were detected. The bilateral pelvic SLN detection rate was better for SPECT/CT (43% (65/151)) than for lymphoscintigraphy (32% (48/151)) (p<0.0001). The overall pelvic SLN detection rate (at least one pelvic SLN detected) was also better with SPECT/CT (77% (16/151)) vs lymphoscintigraphy (68% (102/151)) (p<0.0001). The distribution of SLN locations detected using SPECT/CT was as follows: external iliac, 91 (45%); obturator, 61 (30%); common iliac, 28 (14%); internal iliac, 19 (9%); para-aortic, 2 (1%); parametrium, 2 (1%), and presacral, 1 (1%). The SLN detection rate using SPECT/CT was significantly worse in patients of advanced age (p<0.0001). DISCUSSION Overall and bilateral SLN detection rate was better with SPECT/CT than with lymphoscintigraphy in patients with stage I/II endometrial cancer.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Toshihiko Kawamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Sethi RKV, Abt NB, Remenschneider A, Wang Y, Emerick KS. Value of SPECT/CT for Sentinel Lymph Node Localization in the Parotid and External Jugular Chain. Otolaryngol Head Neck Surg 2018; 159:866-870. [PMID: 29986639 DOI: 10.1177/0194599818786946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/14/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Preoperative single-photon emission computed tomography/computed tomography (SPECT/CT) imaging may aid in the localization of sentinel lymph nodes (SLNs) in cutaneous head and neck malignancy and has been rigorously evaluated for deep cervical lymph nodes. The purpose of this study was to assess the sensitivity, specificity, and positive predictive value (PPV) of SPECT/CT for preoperative localization of nodal basins superficial to the sternocleidomastoid muscle, with comparison to deep nodal basins of the neck. STUDY DESIGN Retrospective review. SETTING Tertiary care center. SUBJECTS AND METHODS SPECT/CT images obtained preoperatively for patients undergoing SLN biopsy for cutaneous head and neck malignancy between June 2015 and June 2016 were reviewed by a blinded nuclear medicine physician and head and neck surgeon. SPECT/CT imaging was compared to intraoperatively determined SLN location via gamma probe. Sensitivity, specificity, and positive and negative predictive values were determined and compared for superficial (external jugular [EJ] and parotid) nodes vs level II nodes. RESULTS Fifty-three patients were included in the study. Most had cutaneous melanoma (69.8%). The PPV of EJ/parotid node identification by SPECT/CT imaging was 85.7%, specificity was 88.9%, and sensitivity was 69.2%. Comparatively, the PPV for level II nodes was 76.9%, specificity was 50%, and sensitivity was 85.7%. No significant difference in SPECT/CT predictive value was identified between EJ/parotid and level II node identification ( P > .05). CONCLUSION SPECT/CT imaging has strong specificity and positive predictability for preoperative localization of SLN superficial to the sternocleidomastoid muscle in cutaneous head and neck malignancy. SPECT/CT imaging may be a useful radiographic aid for preoperative SLN mapping in this patient population.
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Affiliation(s)
- Rosh K V Sethi
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- 2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Nicholas B Abt
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- 2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aaron Remenschneider
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- 2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yingbing Wang
- 3 Department of Nuclear Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin S Emerick
- 1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- 2 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Tew K, Farlow D. Utility of hybrid SPECT/CT in primary melanoma lymphoscintigraphy: A retrospective case series. J Med Imaging Radiat Oncol 2016; 61:204-211. [PMID: 27863028 DOI: 10.1111/1754-9485.12554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sentinel lymph node (SLN) biopsy is widely accepted as an important part of staging cutaneous malignant melanoma. Hybrid single photon emission computed tomography and computed tomography (SPECT/CT) may identify additional SLN and provide important information to the surgeon performing SLN biopsy. We report our experience at a major referral centre for melanoma surgery. METHODS Retrospective case series of pre-operative sentinel node lymphoscintigraphy for primary melanoma over a consecutive 12-month period. All patients had planar imaging and hybrid SPECT/CT. RESULTS At least 1 SLN was successfully identified in 82 of 86 eligible patients (95.3%). These 82 patients had 144 SLNs (mean 1.8). There were no patients where the SLN was seen only with SPECT/CT. Additional information was provided by SPECT/CT in 32 patients (39.0%). Histology reports were available for 52 patients, 9 (17.3%) had at least 1 SLN positive for metastatic disease. CONCLUSIONS We achieved a high rate of SLN identification. SPECT/CT was most frequently helpful when the primary melanoma was located in the head, neck and trunk. Routine use of SPECT/CT during lymphoscintigraphy provides important anatomical information and may reduce the false-negative rate.
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Affiliation(s)
- Khimling Tew
- Department of Nuclear Medicine, PET & Ultrasound, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Farlow
- Department of Nuclear Medicine, PET & Ultrasound, Westmead Hospital, Westmead, New South Wales, Australia
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Role of SPECT-CT in sentinel lymph node biopsy in patients diagnosed with head and neck melanoma. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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López-Rodríguez E, García-Gómez FJ, Álvarez-Pérez RM, Martínez-Castillo R, Borrego-Dorado I, Fernández-Ortega P, Zulueta-Dorado T. Role of SPECT-CT in sentinel lymph node biopsy in patients diagnosed with head and neck melanoma. Rev Esp Med Nucl Imagen Mol 2015; 35:22-8. [PMID: 26150109 DOI: 10.1016/j.remn.2015.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Assess the role of SPECT-CT in sentinel lymph node (SLN) biopsy in the accurate anatomical location of the SNL in patients with cutaneous head and neck melanoma. MATERIAL AND METHODS A retrospective study was conducted from February 2010 to June 2013 on 22 consecutive patients with a diagnosis of cutaneous head and neck melanoma (9 female, 13 male), with a mean age of 55 years old and who met the inclusion criteria for SLN biopsy. Patients underwent preoperative scanning after peri-scar injection of (99m)Tc-labeled-nanocolloid. Planar images of the injection-site, whole-body, and SPECT-CT scanning were acquired. RESULTS Detection rate of SLN reached up to 91% (20/22 patients) by planar lymphoscintigraphy and 95.4% (21/22 patients) by SPECT-CT. SPECT-CT provided an accurate location of SLN in 14/22 patients, enabling to improve the surgical approach (clinical impact: 63.6%). SLN was positive for metastatic cells in 9.1% patients. CONCLUSION SPECT-CT provides detailed anatomical SLN location and allows detecting a higher number of SLN than planar lymphoscintigraphy. Routine use of SPECT-CT is recommended in order to optimise the SLN detection and location in patients with head and neck melanoma.
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Affiliation(s)
- E López-Rodríguez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F J García-Gómez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R M Álvarez-Pérez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Martínez-Castillo
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P Fernández-Ortega
- Servicio de Cirugía Plástica General, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - T Zulueta-Dorado
- Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, España
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8
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SPECT/CT in imaging sentinel nodes. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Remenschneider AK, Dilger AE, Wang Y, Palmer EL, Scott JA, Emerick KS. The predictive value of single-photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy. Laryngoscope 2014; 125:877-82. [DOI: 10.1002/lary.25024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Aaron K. Remenschneider
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Amanda E. Dilger
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Yingbing Wang
- Department of Radiology, Division of Nuclear Medicine & Molecular Imaging; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts U.S.A
| | - Edwin L. Palmer
- Department of Radiology, Division of Nuclear Medicine & Molecular Imaging; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts U.S.A
| | - James A. Scott
- Department of Radiology, Division of Nuclear Medicine & Molecular Imaging; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts U.S.A
| | - Kevin S. Emerick
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
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Mücke J, Klapdor R, Schneider M, Länger F, Gratz KF, Hillemanns P, Hertel H. Isthmocervical labelling and SPECT/CT for optimized sentinel detection in endometrial cancer: technique, experience and results. Gynecol Oncol 2014; 134:287-92. [PMID: 24823647 DOI: 10.1016/j.ygyno.2014.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/30/2014] [Accepted: 05/06/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We evaluated the clinical feasibility of a new injection technique for sentinel detection in endometrial carcinoma (EC), transcervical subepithelial injection into the isthmocervical region of the myometrium. We compared detection of sentinel lymph nodes (SLN) by single photon emission computed tomography with CT (SPECT/CT) with planar lymphoscintigraphy. METHODS This is a unicentric prospective study. In all patients, transcervical injection of 10 MBq Technetium-99m-nanocolloid was performed into the isthmocervical myometrium without anaesthesia. After 40 (30-60) min, lymphoscintigraphy and SPECT/CT were performed. Patent blue was administered before surgery. The number and localisation of SLN detected in SPECT/CT and lymphoscintigraphy were recorded and compared to the SLN and non-SLN dissected intra-operatively. RESULTS Between August 2008 and March 2012, 31 patients with EC were enrolled. The new transcervical injection of labelling substances led to high intra-operative (90.3%) detection rates, pelvic bilateral (57%), para-aortic (25%). SPECT/CT significantly identified more SLN than lymphoscintigraphy (mean 2.2 (1-8) to 1.3 (1-7)) in more patients (29/31 (93.5%) to 21/31 (68%), p<0.01). If SLN were identified in one hemi-pelvis, the histological evaluation of the SLN correctly predicted lymph node (LN) metastases for this basin which led to sensitivity 100%, negative predictive value (NPV) 100%, and false negative results 0%. CONCLUSION Transcervical SLN marking in combination with SPECT/CT is easily applicable and leads to high physiologic detection rates in pelvic and para-aortic lymphatic drainage areas. Non-affected SLN truly predicted a non-affected LN basin. Combining both methods SLN dissection may be a safe and feasible staging technique for clinical routine in EC.
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Affiliation(s)
- J Mücke
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - R Klapdor
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - M Schneider
- Institute of Biometry, Hannover Medical School, Germany
| | - F Länger
- Institute of Pathology, Hannover Medical School, Germany
| | - K F Gratz
- Department of Nuclear Medicine, Hannover Medical School, Germany
| | - P Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany
| | - H Hertel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Germany.
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Martínez Castillo R, Fernández López R, Acevedo Bañez I, Álvarez Pérez R, García Solis D, Vázquez Albertino R, Fernández Ortega P. Utility of single photon emission computed tomography–computed tomography in selective sentinel lymph node biopsy in patients with melanoma. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zender C, Guo T, Weng C, Faulhaber P, Rezaee R. Utility of SPECT/CT for periparotid sentinel lymph node mapping in the surgical management of head and neck melanoma. Am J Otolaryngol 2014; 35:12-8. [PMID: 24140088 DOI: 10.1016/j.amjoto.2013.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Sentinel lymph node (SLN) biopsy is instrumental in staging and treatment of cutaneous melanoma. SPECT/CT, single-photon emission computed tomography (SPECT) integrated with computed tomography (CT), increases the accuracy of SLN mapping to improve surgical planning. SPECT/CT can correct for signal scatter to prevent masking, which is especially common in the head and neck. For periparotid lymph nodes SPECT/CT may improve localization of SLNs compared to lymphoscintigraphy. MATERIALS/METHODS Hospital charts were reviewed for 14 patients with melanoma and suspected lymphatic drainage to the parotid region who received lymphoscintigraphy followed by SPECT/CT prior to surgical excision and SLN. RESULTS Overall, SPECT/CT provided data, which changed management in 57% of patients. CONCLUSIONS Fifty-seven percent of our patients benefited from use of SPECT/CT. The distinction between level II and parotid sentinel lymph nodes was clearly identified through SPECT/CT images. We believe that patients with melanoma draining to the parotid region would benefit from SPECT/CT SLN mapping.
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Affiliation(s)
- Chad Zender
- Department of Otolaryngology, University Hospital, Case Western Reserve University, Cleveland, OH, USA.
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Martínez Castillo R, Fernández López R, Acevedo Bañez I, Alvarez Pérez RM, García Solis D, Vázquez Albertino R, Fernández Ortega P. [Utility of single photon emission computed tomography-computed tomography in selective sentinel lymph node biopsy in patients with melanoma]. Rev Esp Med Nucl Imagen Mol 2013; 33:129-35. [PMID: 24094375 DOI: 10.1016/j.remn.2013.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the contribution of SPECT-CT lymphoscintigraphy in selective sentinel lymph node biopsy (SLNB) in patients with newly diagnosed malignant melanoma. MATERIAL AND METHODS A prospective study was made between July 2009 and October 2010. It included 63 patients diagnosed with melanoma (32 men and 31 women) with mean age of 55 years (range: 25-88) and inclusion criteria for SLNB. The melanomas were located as follows: 28 in trunk, 5 in head and neck, 16 in upper limbs and 17 in lower limbs. Three patients had two melanomas. Preoperative lymphoscintigraphy was performed after pericicatricial/perilesional injection of 74MBq of (99m)Tc-labeled nanocolloid human serum albumin, obtaining early planar images, late whole body study and sectorial images and SPECT-CT in the area of interest. Planar scintigraphy findings were compared with SPECT-CT. RESULTS The sentinel node (SN) was localized by planar imaging in 62/63 (98%) of patients. SPECT-CT study located the SN in all the patients with a detection rate of 100%. The number of SNs detected with SPECT-CT was higher than with the planar study in 27 patients. The SPECT-CT provided additional information (change in location and/or in its accuracy in the localization of location uncertain SN) in 14/63 (22.2%) patients, involving changes in the surgical approach and lymph node staging. CONCLUSION SPECT-CT detects a higher number of SN than planar lymphoscintigraphy in patients with melanoma. Its contribution is more relevant in the melanomas located on the trunk, head and neck. SPECT-CT modified the SN location by 22% compared to planar scan findings, facilitating a correct surgical approach.
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Affiliation(s)
- R Martínez Castillo
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R Fernández López
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Acevedo Bañez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R M Alvarez Pérez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - D García Solis
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Vázquez Albertino
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P Fernández Ortega
- U.G. Cirugía Plástica, Hospital Universitario Virgen del Rocío, Sevilla, España
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Abstract
Sentinel node lymphoscintigraphy and biopsy has become standard practice for lymphatic staging in early-stage breast cancer and melanoma. More recently, sentinel node lymphoscintigraphy has also been used in head and neck squamous cell cancers and other solid tumours. Single photon emission computed tomography/computed tomography (SPECT/CT) is a new tool and this article reviews its potential application in sentinel node imaging. SPECT/CT provides complementary functional and anatomical information and has been shown to be superior to planar imaging in a number of indications. The advantages include more accurate anatomical localization, identification of false positives (due to contamination or spillover from the injection site), reduction in the number of false negatives (visualization of nodes not seen on planar imaging) and alteration of the surgical approach. We thus believe that sentinel lymph node SPECT/CT can provide valuable information before sentinel lymph node biopsy and advocate its use in a range of tumours such as truncal and head and neck melanomas.
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Rietbergen DDD, van den Berg NS, van Leeuwen FWB, Valdés Olmos RA. Hybrid techniques for intraoperative sentinel lymph node imaging: early experiences and future prospects. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stoffels I, von der Stück H, Boy C, Pöppel T, Körber N, Weindorf M, Dissemond J, Schadendorf D, Klode J. Indocyanine green fluorescence-guided sentinel lymph node biopsy in dermato-oncology. J Dtsch Dermatol Ges 2011; 10:51-7. [PMID: 22103392 DOI: 10.1111/j.1610-0387.2011.07843.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) for cutaneous malignancies usually carried out with radioactive nanocolloids (Tc-99m). The SLNE is controversially discussed internationally. This is especially given to the high false-negative rate up to 44 %. An alternative could be the fluorescent dye indocyanine green (ICG). MATERIAL AND METHODS We investigated the advantage of intraoperative fluorescence detection of lymphatic vessels and SLN with a Near-Infrared (NIR) camera in comparison to conventional methods using preoperative lymphoscintigraphy and SPECT/CT in 22 patients with malignant melanoma. RESULTS A total of 61 SLNs were removed in 22 operative procedures. In 7 SLN (10.3 %; 7/68) the histopathological assessment could demonstrate a metasta-tic involvement. 11 additional SLN (19.1 %) in 8 patients were only identified using the fluorescent labeling. Two of these additional SLN (9.1 %; 2/22) showed metastatic involvement. CONCLUSION The ICG fluorescence-guided SLNB is an innovative imaging technique for dermato-oncology, reliable and providing additional information in the detection of SLN. Therefore SLNB with fluorescence-dye is an attractive option with intraoperative real-time lymphoscintigraphy to improve the detection of SLN in cutaneous malignancies and potential reduction of the false negative rate in SLN.
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Affiliation(s)
- Ingo Stoffels
- Department of Dermatology, Venereology and Allergology, University of Essen-Duisburg, Germany
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Rondelli F, Vedovati M, Becattini C, Tomassini G, Messina S, Noya G, Simonetti S, Covarelli P. Prognostic role of sentinel node biopsy in patients with thick melanoma: a meta-analysis. J Eur Acad Dermatol Venereol 2011; 26:560-5. [DOI: 10.1111/j.1468-3083.2011.04109.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vermeeren L, Valdés Olmos RA, Klop WMC, van der Ploeg IMC, Nieweg OE, Balm AJM, van den Brekel MWM. SPECT/CT for sentinel lymph node mapping in head and neck melanoma. Head Neck 2011; 33:1-6. [DOI: 10.1002/hed.21392] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Klode J, Poeppel T, Boy C, Mueller S, Schadendorf D, Körber A, Stoffels I, Dissemond J. Advantages of preoperative hybrid SPECT/CT in detection of sentinel lymph nodes in cutaneous head and neck malignancies. J Eur Acad Dermatol Venereol 2010; 25:1213-21. [DOI: 10.1111/j.1468-3083.2010.03954.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vermeeren L, van der Ploeg IMC, Olmos RAV, Meinhardt W, Klop WMC, Kroon BBR, Nieweg OE. SPECT/CT for preoperative sentinel node localization. J Surg Oncol 2010; 101:184-90. [PMID: 19924723 DOI: 10.1002/jso.21439] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The value of SPECT/CT for detection and localization of sentinel nodes is reviewed. SPECT/CT depicts extra sentinel nodes and identifies non-nodal tracer accumulation. SPECT/CT is indicated in patients with complex lymphatic drainage as often present in patients with head, neck and scapular melanoma, breast cancer patients with extra-axillary sentinel nodes and patients with tumors draining to pelvic nodes. SPECT/CT also clarifies the drainage pattern of inconclusive conventional images (non-visualization or unclear location of the nodes).
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Affiliation(s)
- Lenka Vermeeren
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands.
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Sentinel node detection in head and neck malignancies: innovations in radioguided surgery. JOURNAL OF ONCOLOGY 2009; 2009:681746. [PMID: 20016804 PMCID: PMC2792958 DOI: 10.1155/2009/681746] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 09/17/2009] [Indexed: 11/18/2022]
Abstract
Sentinel node mapping is becoming a routine procedure for staging of various malignancies, because it can determine lymph node status more precisely. Due to anatomical problems, localizing sentinel nodes in the head and neck region on the basis of conventional images can be difficult. New diagnostic tools can provide better visualization of sentinel nodes. In an attempt to keep up with possible scientific progress, this article reviews new and innovative tools for sentinel node localization in this specific area.
The overview comprises a short introduction of the sentinel node procedure as well as indications in the head and neck region. Then the results of SPECT/CT for sentinel node detection are described. Finally, a portable gamma camera to enable intraoperative real-time imaging with improved sentinel node detection is described.
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SPECT-TAC en la localización del ganglio centinela en pacientes con melanoma. ACTA ACUST UNITED AC 2009; 28:229-34. [DOI: 10.1016/j.remn.2009.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 03/03/2009] [Indexed: 11/21/2022]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:132-41. [PMID: 19363348 DOI: 10.1097/moo.0b013e32832ad5ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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