Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies

Abstract

We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors. Methods: From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of 99m Tccolloid particles. Surgery was performed the same or next day. Results: Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P , 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer. Conclusion: SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI. The status of regional lymph nodes is a major prognostic factor in many malignant tumors. Sentinel lymph node (SN) biopsy in patients with clinically node-negative tumors is a validated technique for accurate staging of nodal disease in breast cancer (1,2) and melanoma (3,4) and is being used with promising results in other solid tumors including pelvic malignancies (5,6). The use of SN mapping in an increasing list of tumors shows a variety of lymphatic drainage basins containing the SN (7). SNs are the lymph nodes draining the primary tumor and therefore the most likely to contain tumor cells spreading to the drainage basin (8). Assuming an orderly progression of lymph flow, the tumor status of the SN predicts the status of the regional draining basin (1). Selective SN biopsy enables the detection of metastatic and occult micrometastatic nodal involvement by thorough histopathologic examination in the intraoperative setting, sparing patients a systematic regional lymphadenectomy when the node is negative.Planar lymphoscintigraphy (PI) after local injection of radiocolloid is well suited for the mapping of regional lymph nodes, but occasionally no SNs are visualized, for instance, in obese patients or when SNs are located too close to the injection site. In addition, the anatomic information provided by planar scintigraphy is limited and the exact SN location is difficult to define in deeply located nodes (9,10). Unexpected basin drainage sites and unpredictable pathways also hinder interpretation of planar images. Because of its superior contrast, resolution, and display of exact anatomic landmarks, SPECT...

Value of planar lymphoscintigraphy (PL) versus SPECT/CT in evaluation of sentinel lymph node in trunk melanoma — one center, large series retrospective study

“…This allows for much greater accuracy of anatomical localization and provides more information relevant for SLNB, making it the "gold standard" in skin melanoma and breast cancer diagnostic process [11,15,16]. Nevertheless the number of publications comparing both techniques (PLvs SPECT-CT lymphoscintigraphy) on large groups of patients is limited, especially single-centered.…”

Hibrid képalkotás: klinikai evidenciák, lehetőségek

“…A hibrid technológia másik nagy előnye a klinikai alkalmazásban, hogy pontosan lokalizálhatók a patológiás dúsulások és nagy biztonsággal elkülöníthetők a fi ziológiás halmozásoktól. Egy közelmúltban megjelent multicentrikus tanulmányban Jimenez-Heffernan és mtsai [2] igazolták, hogy a SPECT/CT vizsgálat több nyirokcsomót mutat ki és biztosabban ítéli meg a nyirokdrenázs útját, mint a konvencionális planáris vizsgálat (1. ábra). Wong és mtsai [3] metaanalízis-vizsgálatukban beszámoltak arról, hogy a 99m Tc-MIBI fúziós SPECT/CT képalkotással pontosabban detektálhatók a hiperfunkcionáló parathyreoidea-…”

SPECT/CT imaging in breast cancer - current status and challenges

“…In a recent IAEA multicentre study 48 SPECT/CT increased the visualisation rate from 87.6% to 91.3%. However, an alternative way for increasing SLN visualisation is tracer reinjection and Pouw 49 compared both procedures in patients with SLN non-visualisation after intra-tumoural tracer administration.…”

“…According to a prospective multicentre study organized by IAEA (ref. 48 ), the SPECT/CT provides a more accurate localization of the SLN previously displayed on planar scans after peritumoral or subareolar application of radiopharmaceuticals or a combination. Part of the SLN displayed on planar scans in the axilla was localized using SPECT/CT much more precisely in the interpectoral or intramammary region.…”