SPECT/CT for sentinel lymph node mapping in head and neck melanoma

Vermeeren, Lenka; Olmos, Renato A. Valdés; Klop, W. Martin C.; Ploeg, Iris M. C. van der; Nieweg, Omgo E.; Balm, Alfons J. M.; Brekel, M.W.M. van den

doi:10.1002/hed.21392

Cited by 93 publications

(48 citation statements)

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“…The lower-than-reported (10) adjustment rate in breast cancer patients may be explained by the fact that internal mammary and other extraaxillary SNs were not excised routinely in all centers. The global melanoma adjustment rate agrees with previous study results (19,26,29), together with the finding of the greatest benefit for patients with head and neck (30) and trunk (26) locations. This is not surprising because prediction of the lymphatic drainage pathways of melanoma of the head and neck is difficult in a region with more than 350 small lymph nodes and fast tracer uptake (31).…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2015

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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...

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Section: Discussionsupporting

confidence: 91%

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

et al. 2015

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“…To provide an overview of the SLNs with regard to their anatomical location, single photon emission computed tomography combined with computed tomography (SPECT/ CT) was introduced. Additionally, with SPECT/CT more SLNs can be visualized compared to conventional lymphoscintigraphy [13]. Intraoperatively, SLN localization is commonly guided by the acoustic signal coming from a handheld gamma ray detection probe.…”

Section: Introductionmentioning

confidence: 99%

Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99mTc-nanocolloid

Berg

Brouwer

Klop

et al. 2012

Eur J Nucl Med Mol Imaging

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155

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“…In the preoperative setting, the lymphatic drainage pattern can gradually be visualized using sequential lymphoscintigraphy, enabling identification of the first tumor-draining (sentinel) lymph nodes (8). SPECT combined with CT complements lymphoscintigraphy with 3-dimensional anatomic data and can sometimes reveal additional sentinel nodes (9)(10)(11).…”

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confidence: 99%

Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–^99mTc-Nanocolloid with ^99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT

Brouwer¹,

Buckle²,

Vermeeren³

et al. 2012

J Nucl Med

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212

113

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The purpose of this study was to compare the lymphoscintigraphic drainage patterns of a hybrid sentinel node tracer consisting of the fluorescent dye indocyanine green (ICG) and 99m Tc-nanocolloid with the drainage pattern of 99m Tc-nanocolloid alone, the current standard tracer in many European countries. Methods: Twenty-five patients with a melanoma in the head and neck region (n 5 10), a melanoma on the trunk (n 5 6), or penile carcinoma (n 5 9) who were scheduled for sentinel node biopsy were prospectively included. First, the standard 99m Tc-nanocolloid procedure was performed. After injection at the lesion site, lymphoscintigraphy was performed with a 10-min dynamic study and static planar images at 10 min and 2 h after injection, followed by SPECT/CT. The same scintigraphic procedure was repeated after injection of hybrid ICG-99m Tcnanocolloid the same afternoon in 10 patients or the next morning in 15 patients. The paired images of both injections were evaluated, and count rates in the sentinel nodes were calculated and compared. Sentinel nodes were surgically localized using blue dye, a g-ray detection probe, a portable g-camera, and a fluorescence camera. Results: Lymphatic drainage was visualized in all 25 patients using 99m Tc-nanocolloid, leading to the identification of 66 sentinel nodes in total. These same sentinel nodes were also identified during the second scintigraphic procedure with ICG-99m Tc-nanocolloid. Moreover, a high correlation between the radioactive counting rates in the sentinel nodes of both scintigraphic studies was observed (mean R 2 5 0.83). Intraoperatively (4-23 h after the second injection), all preoperatively identified sentinel nodes could be localized using radio-and fluorescence guidance combined. In total, 95% of the sentinel nodes could be intraoperatively visualized by means of fluorescence imaging, whereas merely 54% stained blue. Ex vivo, all radioactive sentinel nodes were fluorescent and vice versa. No adverse reactions were observed. Conclusion: The lymphatic drainage pattern of ICG-99m Tc-nanocolloid is identical to that of 99m Tc-nanocolloid. This observation, together with the added value of intraoperative fluorescence guidance, warrants wider evaluation of hybrid ICG-99m Tc-nanocolloid as a tracer for sentinel node procedures.

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SPECT/CT for sentinel lymph node mapping in head and neck melanoma

Abstract: SPECT/CT visualizes more sentinel nodes than conventional images and shows their anatomic location. SPECT/CT is recommended in patients with a melanoma in the head or neck.

Cited by 93 publications

References 21 publications

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

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

Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99mTc-nanocolloid

Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–^99mTc-Nanocolloid with ^99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT

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SPECT/CT for sentinel lymph node mapping in head and neck melanoma

Abstract: SPECT/CT visualizes more sentinel nodes than conventional images and shows their anatomic location. SPECT/CT is recommended in patients with a melanoma in the head or neck.

Cited by 93 publications

References 21 publications

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

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

Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-99mTc-nanocolloid

Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–99mTc-Nanocolloid with 99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT

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Comparing the Hybrid Fluorescent–Radioactive Tracer Indocyanine Green–^99mTc-Nanocolloid with ^99mTc-Nanocolloid for Sentinel Node Identification: A Validation Study Using Lymphoscintigraphy and SPECT/CT