Lymphoscintigraphy and Sentinel Nodes

Abstract

Learning Objectives: On successful completion of this activity, participants should be able to describe (1) generic fundamentals of lymphoscintigraphy procedures of sentinel lymph node biopsy (SLNB) protocols; (2) specific injection and imaging components of SLNB protocols used in the management of patients with breast cancer, melanoma, and head and neck malignancies; and (3) specific indications of breast cancer, melanoma, and head and neck malignancies that suggest inclusion of a SLNB in the management of a patient.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through June 2018.It has been validated that sentinel lymph node biopsy (SLNB) shows whether a patient's breast cancer or melanoma has spread to regional lymph nodes. As a result, management of patients with these cancers has been revolutionized. SLNB has replaced axillary lymph node dissection (ALND) as the staging modality of choice for early breast cancer and has replaced complete lymph node dissection as the staging modality of choice for melanoma in patients whose SLNBs indicate no metastases. Recently concluded multicenter, randomized trials for breast cancer with 5-to 10-y outcome data have shown no significant differences in disease-free survival rates or overall survival rates between SLNB and ALND groups but have shown significantly lower morbidity with SLNB than with ALND. The lowest false-negative rates (5.5%-6.7%) were seen in studies that used preoperative lymphoscintigraphy and dual mapping during surgery. To assess the survival impact of SLNB in melanoma, the Multicenter Selective Lymphadenectomy Trial I was performed. Melanoma-specific survival rates were not different between subjects randomized to SLNB with lymphadenectomy for nodal metastasis on biopsy and subjects randomized to observation with lymphadenectomy for nodal relapse. However, the 10-y disease-free survival rates were better for the SLNB group than for the observation group, specifically among patients with intermediate-thickness melanomas or thick melanomas.

Contrast-enhanced ultrasound imaging in vivo with laser-activated nanodroplets

“…Therefore, detecting and assessing the sentinel lymph node (SLN), which is the first lymph node to which cancer cells drain from a primary tumor, is crucial. To identify the SLN, researchers have explored numerous biomedical imaging techniques . Classically, lymphoscintigraphy with radiocolloid injection has been widely used for preoperative lymph node imaging, but its imaging resolution is relatively low .…”

Technetium-99m-labeled rituximab for use as a specific tracer of sentinel lymph node biopsy: a translational research study

“…A specific lymphoscintigraphy pharmaceutical, 99m Tc-tilmanocept, was approved by the U.S. FDA for SLN protocols for patients with breast cancer and melanoma in 2013 and for patients with head and neck squamous cell carcinoma in 2014 [18]. 99m Tc-tilmanocept is a receptor-based radiotracer that can specifically bind to mannose receptors (CD206), which are found in high concentrations on the surface of macrophages and dendritic cells [19].…”

“…In this study, data demonstrated that SPECT/CT can be useful in several situations: 1) if SLN is not detected; 2) if extra-axillary lymph nodes are detected; 3) if an internal mammary lymph node is detected; 4) if a contamination is suspected; or 5) if a patient has a high body mass index, has undergone previous breast surgery, or has contralateral uptake [18, 28, 29].…”

Nuclear imaging in the field of dentistry: a review

“…The goal of lymphoscintigraphy is to identify and localize all sentinel lymph nodes(SLNs) for surgical biopsy (34). The SLN is the first lymph node receiving drainage from the primary tumor.…”