Comparison of 99mTc-Labeled Colloid SPECT/CT and Planar Lymphoscintigraphy in Sentinel Lymph Node Detection in Patients with Melanoma: A Meta-Analysis

Abstract

We compared the detection rate (DR) for sentinel lymph nodes (SLNS), the number of SLNs and the subjects with additional SLNs of single-photon emission computed tomography (SPECT/CT) and planar lymphoscintigraphy (PL) in patients with melanoma. Furthermore, we evaluated the impact of SPECT/CT on surgical plans. Articles containing head-to-head comparisons between SPECT/CT and PL were searched in Pubmed/MEDLINE and Scopus. The literature search was updated until December 31st, 2019. DR was calculated on a per-patient-based analysis; the studies were pooled by their odds ratios (ORs) with a random effects model to assess the significance of difference (p < 0.05). The number of additional SLNs (calculated as the relative risk) and pooled proportion of patients with additional SLNs were investigated. The pooled ratio of surgical procedures influenced by the SPECT/CT findings was calculated. Seventeen studies with 1438 patients were eligible for the calculation of DR of SPECT/CT and PL. The average DR was 98.28% (95% confidence interval (95% CI): 97.94–99.19%) for the SPECT/CT and 95.53% (95% CI: 92.55–97.77%) for the PL; OR of 2.31 (95% CI: 1.66–4.18, p < 0.001) in favor of the SPECT/CT. There was a relative risk of a higher number of SLNs (1.13) for the SPECT/CT and 17.87% of patients with additional SLNs were detected by SPECT/CT. The average impact of SPECT/CT on surgery resulted in 37.43% of cases. This meta-analysis favored SPECT/CT over PL for the identification of SLNs in patients with melanoma due to a higher DR, reproducibility, number of SLNs depicted, proportion of patients with additional SLNs and the impact on the surgical plan. However, PL remains a good option due to the high values of the DR for SLNs.

Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes

“…23 A recent meta-analysis demonstrated a higher overall SLN detection rate and proportion of patients with additional SLNs. 24 Another study highlighted the health economic benefit of this approach. 25 Our data are consistent with the previous literature in that we found a significantly increased number of SLNs and were identified by SPECT/ CT compared with LSG (median 3 vs. 2; p \ 0.0001) (Table 1).…”

Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments

“…Lymphoscintigraphy is currently the ‘gold standard’ imaging technique for the diagnosis of extremity lymphedema when the clinical diagnosis is uncertain and, indeed, provides a clear image of the lymphatic drainage status of the upper limb [ 37 , 38 ]. Lymphoscintigraphy involves injection of a radiotracer in the hand and analysis of proximal lymph node uptake.…”

“…Some centers have reported also quantitative analysis based on decay-adjusted uptake and lymphatic transport index; however these are not commonly performed [ 39 , 40 ]. Recently, single photon emission computed tomography-computed tomography (SPECT-CT) lymphoscintigraphy has been used for the diagnosis of lymphedema providing 3-D live images of lymph flow [ 38 , 41 , 42 ]. A recent study reported significant association between the type of dermal backflow, the lymph flow pathways, and the visualization of lymph nodes around the clavicle [ 42 ].…”

Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizon

“…In addition to melanoma and breast cancer, SNL lymphoscintigraphy is used and investigated in surgical planning applications for multiple malignancies including head and neck, valvular, cervical, and prostate cancers [ 75 , 76 , 77 , 78 , 79 , 80 ]. Utilizing SPECT/CT with lymphoscintigraphy improves anatomical localization and detection rate of lymphoscintigraphy [ 81 , 82 ]. Multiple factors can affect lymphoscintigraphy including BMI, age, and tumor location.…”