The Additional Value of Lymphatic Mapping with Routine SPECT/CT in Unselected Patients with Clinically Localized Melanoma

Veenstra, Hidde J.; Vermeeren, Lenka; Olmos, Renato A. Valdés; Nieweg, Omgo E.

doi:10.1245/s10434-011-2031-6

Cited by 54 publications

(19 citation statements)

References 11 publications

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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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“…In another study, concerning 18 melanoma patients, a visualisation rate of 100 % was found for SPECT/CT versus 89 % for planar lymphoscintigraphy; furthermore, SPECT/CT also provided additional anatomical information leading to an adjustment of the surgical approach in four patients [5]. These findings were confirmed in another series including 35 melanoma patients; SPECT/ CT detected additional SNs in seven of them and contributed to modify the surgical approach in ten [6]. More recently, SPECT/CT and planar lymphoscintigraphy detected SNs in 32 patients, both techniques having a visualisation rate of 97 %; however, SPECT/CT contributed to the decision to adjust the surgical approach in 12 patients [7].…”

Section: Cutaneous Melanomamentioning

confidence: 78%

SPECT/CT and sentinel node lymphoscintigraphy

Olmos

Rietbergen

Vidal-Sicart

2014

Clin Transl Imaging

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The use of single-photon emission computed tomography/computed tomography (SPECT/CT) for sentinel node (SN) detection has been evaluated in the majority of malignancies with predominantly superficial lymphatic drainage. In breast cancer and melanoma, important initial contributions of SPECT/CT were based on the anatomical localisation of SNs already visualised on planar images, the detection of additional SNs in aberrant basins, and the depiction of SNs in cases with no visualisation on planar images. However, more recently, the finding that SPECT/CT use is associated with a higher rate of SN detection, more metastatic SNs, and a higher rate of disease-free survival in large series of patients is leading SPECT/CT to be routinely performed in melanoma. The incorporation of SPECT/CT into the SN procedure in melanoma also appears to be cost effective and was significantly related to shorter operative times, shorter hospital stays, and fewer complications. In penile and vulvar cancer, the use of SPECT/CT has led to the detection of additional SNs. In oral cavity cancer and thyroid cancer, SPECT/CT not only appears to be useful for planar image interpretation but is also becoming an essential component of the SN procedure, providing surgeons with additional anatomical information. As regards malignancies with deep lymphatic drainage, SPECT/CT has been extensively validated in urological and gynaecological cancers. In these malignancies, SPECT/CT was able to localise SNs not only in the basins included in the area of extended pelvic lymph node dissection but also in aberrant locations. In gastrointestinal and lung malignancies, SPECT/CT has been used only incidentally. SPECT/CT must be considered complementary to planar lymphoscintigraphy for SN identification, and a combined interpretation of both modalities is necessary. With the improvement of the CT component, nuclear physicians today can also identify lymph nodes corresponding to radioactive SNs. This visual information is helpful for the intraoperative procedure and for postexcision assessment using portable devices.

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“…Preoperative SPECT/CT imaging has been shown to make intraoperative SN biopsy procedure in melanoma patients easier [10,11], with significantly more SNs detected [12] as well as patient benefit [13]. In this context, intraoperative technologies that exploit the 3D SPECT/CT information may increase its value even further.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of SPECT/CT-based mixed-reality navigation towards the sentinel node in patients with melanoma or Merkel cell carcinoma of a lower extremity

Berg

Engelen

Brouwer

et al. 2016

Nuclear Medicine Communications

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The Additional Value of Lymphatic Mapping with Routine SPECT/CT in Unselected Patients with Clinically Localized Melanoma

Abstract: SPECT/CT provided relevant additional information in 16 (46%) of the 35 patients. Routine use of SPECT/CT in addition to conventional lymphoscintigraphy is recommended in melanoma patients undergoing lymphatic mapping.

Cited by 54 publications

References 11 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

SPECT/CT and sentinel node lymphoscintigraphy

A pilot study of SPECT/CT-based mixed-reality navigation towards the sentinel node in patients with melanoma or Merkel cell carcinoma of a lower extremity

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