SPECT/CT in sentinel node imaging

Wagner, Thomas; Buscombe, J. R.; Gnanasegaran, Gopinath; Navalkissoor, Shaunak

doi:10.1097/mnm.0b013e32835c5a24

Cited by 54 publications

(32 citation statements)

References 49 publications

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“…These visualization rates are in accordance with the reported 63%-88% for breast cancer (14,16,17), 82%-99% for melanoma (18), and 84%-91% for gynecologic and prostate cancers (6,7,21). SPECT/CT improved the visualization rates to 91.3% for breast cancer, 99.2% for melanoma, and 95.3% for pelvic cancer, again in agreement with the reported rates of 81%-97.3% for breast cancer (16)(17)(18), near 100% for melanoma (18), and 92.2%-100% for gynecologic and prostate cancers (6,7,21,22). SPECT/CT depicted SNs in 3.7% of breast cancer, 0.4% of melanoma, and 4.7% of pelvic cancer patients, respectively, with no SNs visualized on PI, representing a considerable number of patients who would have undergone lymphadenectomy if only PI was performed.…”

Section: Discussionsupporting

confidence: 80%

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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: 80%

“…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/CT can overcome most of these limitations (11)(12)(13)(14)(15)(16)(17)(18).…”

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confidence: 99%

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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“…These include improved anatomical localization of sentinel lymph nodes and alteration in the surgical approach, identification of false positive planar findings of hot nodes and better detection rates of sentinel lymph nodes due to better spatial resolution [16]. Valdes et al and other studies also provide similar result [17].…”

Section: Ct In Conjunction With Single Photon Emission Tomography (Spsupporting

confidence: 69%

“…This dual modality provides complementary functional and anatomical information and thus is superior to planar imaging [16]. Images from each modality can be fused or used separately.…”

Section: Ct In Conjunction With Single Photon Emission Tomography (Spmentioning

confidence: 99%

Evaluation of a Novel Hand Held Gamma Camera for Intra-Operative Single Photon Emission Computed Tomography

Nair¹

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Cancer when detected at an early stage, before it has spread, can often be treated successfully by surgery or local irradiation. However, when cancer is detected only after it has metastasized, treatments are much less successful.The lymphatic system is a primary path by which malignant cells can travel to other organs in the body. Thus determination of the presence or absence of malignant cells in lymph nodes to which a primary tumor drains is a key component of cancer staging. Sentinel lymph node biopsy (SLNB) has been developed over the past decade as a minimally invasive technique to assess regional lymph node status in patients with malignancy.Despite its routine role in clinical management of cancer, SLNB has a higher false-negative rate (5-10%) than is generally recognized. The current standard of care in SLNB employs a non-imaging gamma probe to locate and excise the sentinel nodes. We are exploring whether the use of a 3-D intraoperative imaging system using a hand held gamma camera could provide advantages compared to the use of the non-imaging probe. The 3-D intraoperative system has been developed through a collaborative effort involving UVa, Dilon Technologies Inc. (Newport News, Virginia), the Jefferson Lab (Newport News, VA) and SurgicEye, (München, Germany). iv The system's hand held camera has a circular field of view (FOV) of diameter 60 mm and comprises a pixelated NaI(Tl) crystal array coupled to an array of silicon photomultipliers (SiPMs). In 3-D operation an optical tracking system consisting of both visual and infrared (IR) cameras tracks the location and orientation of the camera as it is moved by the surgeon. A fast iterative reconstruction algorithm uses the streamed camera data to produce and display the image of the nodes.This thesis evaluates the 2-D and 3-D imaging performance of the hand held gamma camera system. Performance metrics include energy resolution, 2D and 3D spatial resolution, gamma ray detection sensitivity, geometric linearity, attenuation compensation, activity quantification accuracy, and the effect of scatter radiation from the radiotracer injection site.Chapter 1 gives an overview of the current practices of sentinel lymph node biopsy and the various intra-operative surgical guidance modalities that can be used for assistance in the detection of sentinel lymph nodes. This chapter also throws light on some of the drawbacks associated with each of the modalities. Chapter 2 gives a summary of some of the contemporary small gamma cameras that have been developed and used for the detection of cancerous masses and lesions. It also introduces the declipseSPECT system with v the gamma probe and the gamma camera, which forms the crux of this thesis.Chapter 3 gives a detailed explanation of the performance evaluation experiments that were carried out using this novel gamma camera. Chapter 4 concludes this thesis, summarizing the results and comparing them with the other small gamma cameras. Chapter 5 briefly discusses the clinical studies planned with the hand held...

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“…Wagner 47 described the benefits of using SPECT/CT in a precise anatomical localization of lymph nodes with a relationship to surrounding anatomical structures. He confirmed the identification of additional lymph nodes that were not visible on a planar scan and highlighted the reduction of potential artefacts (a skin contamination) or technical difficulties after application of the radiopharmaceutical.…”

Section: Spect/ct Improve the Localization Of Displayed Lymph Nodesmentioning

confidence: 99%

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

Simanek

Koranda²

2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. The increasing incidence of breast cancer worldwide raises the importance of improving imaging techniques for disease stratification after early lesion detection. SPECT/CT imaging is now widely available but its diagnostic potential is not fully utilized for more specific purposes including breast cancer patient stratification. Methods and Results. A Pubmed search for both original and review articles related to the value of SPECT/CT in breast cancer patients and comparison to other diagnostic methods. 62 articles were found using the key words SPECT/CT, Fusion Image and Breast Cancer. Development of a new generation of SPECT/CT systems and their introduction into practice has changed the old diagnostic algorithm. The increasing importance of SPECT/CT in the detection of bone metastases is confirmed. The diagnostic accuracy of new SPECT/CT instruments in the diagnostics of bone metastases is nearly comparable to PET/CT scans. SPECT/CT is more widely available and costs less than PET. It is able not only to identify a sentinel lymph nodes in atypical localizations but also to detect sentinel lymph nodes non visualized on previous planar scans. SPECT/CT offers precise anatomic localization of sentinel lymph nodes, thereby facilitating surgery. Knowledge of precise sentinel lymph node localization can also be applied in radiotherapy. Conclusions. The role of hybrid SPECT/CT imaging in breast cancer patients is changing. It is a powerful modality for skeletal and nodal staging in breast cancer patients with important impact on therapy.

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SPECT/CT in sentinel node imaging

Cited by 54 publications

References 49 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

Evaluation of a Novel Hand Held Gamma Camera for Intra-Operative Single Photon Emission Computed Tomography

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

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