Potential advantage of studying the lymphatic drainage by sentinel node technique and SPECT-CT image fusion for pelvic irradiation of prostate cancer

Krengli, Marco; Ballarè, Andrea; Cannillo, Barbara; Rudoni, Marco; Kocjancic, Ervin; Loi, G.; Brambilla, Marco; Inglese, Eugenio; Frea, Bruno

doi:10.1016/j.ijrobp.2006.06.047

Cited by 45 publications

(30 citation statements)

References 20 publications

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“…In 11 patients, fusion images correlated reasonably well with intraoperative findings: 87% of the lymph node locations visualized on SPECT/CT fusion images were confirmed by the surgeons (20). Furthermore, Krengli et al described how preoperative imaging of lymph drainage with SPECT/CT in prostate cancer patients can alter the radiotherapy regime and lead to optimization of pelvic irradiation (21).…”

Section: Discussionmentioning

confidence: 99%

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Vermeeren¹,

Olmos²,

Meinhardt³

et al. 2009

J Nucl Med

106

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Laparoscopic evaluation of sentinel nodes is useful for staging prostate cancer, but preoperative localization of deep abdominal sentinel nodes with planar lymphoscintigraphy is difficult. We evaluated the value of SPECT/CT for detecting and localizing sentinel nodes in prostate cancer. Methods: 99m Tc-nanocolloid was injected peri-and intratumorally, guided by transrectal ultrasonography, in 46 patients with prostate cancer of intermediate prognosis. Patients underwent planar imaging after 15 min and 2 h, SPECT/CT after 2 h, and laparoscopic sentinel node lymphadenectomy on the same day. SPECT was fused with CT and analyzed using 2-dimensional orthogonal slicing and 3-dimensional volume rendering. We evaluated the number of extra sentinel nodes found by SPECT/CT, the number of sentinel nodes found by SPECT/CT outside the area of the extended pelvic lymphadenectomy, and the anatomic information provided by SPECT/CT. Furthermore, we classified the value of the additional SPECT/CT images into 3 categories (no advantage, presumable advantage, and definite advantage) according to the extra anatomic information given and whether additional sentinel nodes were found by SPECT/CT. Results: The patients had a mean age of 64 y (range, 53-74 y) and received a mean injected dose of 218 MBq (range, 147-286 MBq). The sentinel node visualization rate was 91% (42 patients) for planar imaging and 98% (45 patients) for SPECT/CT. In 29 of the 46 patients (63%), SPECT/CT revealed additional sentinel nodes (especially lymph nodes near the injection area) not seen on planar imaging. In 7 patients, those additional sentinel nodes were positive for metastasis (being the exclusive metastatic sentinel node in 4 patients). Overall, 15 patients (33%) had positive sentinel nodes. Sentinel nodes outside the area of extended pelvic lymphadenectomy were found in 16 patients (35%), whereas in 56% of these patients those nodes were not seen on planar imaging. Performing SPECT/CT had no advantage in 13% of the patients, a presumable advantage in 24%, and a definite advantage in 63%. Urologic surgeons used the SPECT/CT images to guide their trocar insertion sites and sentinel node finding with the probe. Conclusion: More sentinel nodes can be detected with SPECT/CT than with planar imaging alone. In comparison with planar imaging, SPECT/CT especially reveals extra sentinel nodes near the prostate and outside the area of the extended pelvic lymphadenectomy. Furthermore, the modality provides useful additional information about the anatomic location of sentinel nodes within and outside the pelvic area, leading to improved intraoperative sentinel node identification.

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Section: Discussionmentioning

confidence: 99%

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Vermeeren¹,

Olmos²,

Meinhardt³

et al. 2009

J Nucl Med

106

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“…Figure 4 shows an example of a presacral sentinel node that is only visualized on SPECT/CT images. Preoperative imaging of lymph drainage with SPECT/CT can also alter the targeted radiotherapy field and optimize pelvic irradiation [48].…”

Section: Spect/ct In Patients With Other Malignanciesmentioning

confidence: 99%

SPECT/CT for preoperative sentinel node localization

Vermeeren

Ploeg

Olmos

et al. 2010

Journal of Surgical Oncology

118

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The value of SPECT/CT for detection and localization of sentinel nodes is reviewed. SPECT/CT depicts extra sentinel nodes and identifies nonnodal tracer accumulation. SPECT/CT is indicated in patients with complex lymphatic drainage as often present in patients with head, neck and scapular melanoma, breast cancer patients with extra-axillary sentinel nodes and patients with tumors draining to pelvic nodes. SPECT/CT also clarifies the drainage pattern of inconclusive conventional images (non-visualization or unclear location of the nodes).

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“…pimonidazole, EF5) (16)(17)(18). In addition to these invasive techniques, positron emission tomography (PET) (19,20) and single-photon emission computed tomography (SPECT) with CT image fusion (21) hold promise for identifying tumor hypoxia non-invasively at both the global and local level. Many hypoxia-targeting molecules labeled with positron-emitting radionuclides have been developed (19,20,(22)(23)(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Helzel and OxyLite Systems in the Measurements of Tumor Partial Oxygen Pressure (pO₂)

et al. 2008

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It has been demonstrated in both experimental and human malignancies that hypoxic tumor cells are linked with aggressive disease phenotype. One of the methods to identify these cells is by direct physical measurement of tumor pO 2 . This study compared pO 2 values measured with two systems, the Helzel Hypoximeter (successor of the polarographic Eppen-dorf electrode) and the OxfordOptronix OxyLite (fiber-optic probe), in R3327-AT and R3327-AT/tkeGFP tumors. Partial oxygen pressure was measured in individual tumors with either system or in the same tumor with both systems. The similarities and discrepancies in pO 2 measurements between the two systems were also investigated when tumor-bearing animals were breathing pure oxygen. Our data showed a considerable heterogeneity in pO 2 values in each tumor using both the Helzel and OxyLite systems. Similar results were obtained with both systems for the mean and median pO 2 values, and the distributions of pO 2 values within the interval 0 < pO 2 < 40 mmHg (the range important for defining tumor hypoxia) were found to be statistically equivalent However, the frequencies of high pO 2 values (>40 mmHg) and zero values measured by the two systems were statistically significantly different.

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Potential advantage of studying the lymphatic drainage by sentinel node technique and SPECT-CT image fusion for pelvic irradiation of prostate cancer

Cited by 45 publications

References 20 publications

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

SPECT/CT for preoperative sentinel node localization

Comparison of Helzel and OxyLite Systems in the Measurements of Tumor Partial Oxygen Pressure (pO₂)

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Potential advantage of studying the lymphatic drainage by sentinel node technique and SPECT-CT image fusion for pelvic irradiation of prostate cancer

Cited by 45 publications

References 20 publications

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

Value of SPECT/CT for Detection and Anatomic Localization of Sentinel Lymph Nodes Before Laparoscopic Sentinel Node Lymphadenectomy in Prostate Carcinoma

SPECT/CT for preoperative sentinel node localization

Comparison of Helzel and OxyLite Systems in the Measurements of Tumor Partial Oxygen Pressure (pO2)

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Comparison of Helzel and OxyLite Systems in the Measurements of Tumor Partial Oxygen Pressure (pO₂)