Single photon emission computed tomography SPECT-CT improves sentinel node detection and localization in cervical and uterine malignancy

Pandit‐Taskar, Neeta; Gemignani, Mary L.; Lyall, Ashima; Larson, Steven M.; Barakat, Richard R.; Rustum, Nadeem R. Abu

doi:10.1016/j.ygyno.2009.12.021

Cited by 79 publications

(49 citation statements)

References 26 publications

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“…The SLN protocol of enhanced pathologic evaluation of removed nodes may also provide a much more detailed evaluation of these nodes and the potential for identifying micrometastasis that may have been missed with traditional pathologic evaluation [16] . Accurate visualization of the SLN is required for the best results.…”

Section: Introductionmentioning

confidence: 99%

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Kraft

Havel

2012

JBGC

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Background: The most important prognostic factor in melanomas, breast cancers and gynecologic tumors is the state of the lymph nodes (LNs). There is not suitable pre-surgery examination procedure of detection of impacted LNs. The use of lymphatic mapping of sentinel lymph node (SLN) helps reduce the morbidity of surgery. Accurate visualization of the SLN is required for the best results. The aim is to assess the role of planar lymphoscintigraphy and fusion imaging of SPECT/CT in SLN detection in patients with various types of tumors and estimation of some factors influencing detection success -age, gender and body mass index (BMI). Methods:Planar scintigraphy and hybrid modality SPECT/CT were performed in 550 patients (pts) (mean age 58.1 ± 13.1 years): 69 pts with gynecological tumors (37 with cervical cancer, 25 pts with endometrial cancer, 7 pts with vulvar carcinoma); in 161 pts with melanomas; and in 318 women and 2 men with breast cancer. The radiopharmaceutical was injected around the tumor, subareolar or around the scar. Planar and SPECT/CT images were interpreted separately by two nuclear medicine physicians. Efficacy of these two techniques to image SLN were compared. We have estimated the influence of the age, gender and BMI on the succes rate of SLN detection. Student's paired t-test was used for comparing numbers of found SLN by both techniques; F-test, Student's t-test, and Fisher's exact test were utilized for age, gender and BMI characteristics comparisons. Values were considered significant when P<0.05. Results:Planar scintigraphy did not image SLN in 77 pts in total (14.0 %); in 8 pts with gynecologic tumors, in 23 pts with melanomas and in 46 pts with breast cancer. SPECT/CT was negative in 49 pts (8.9 %) in total; in 4 pts with gynecologic tumors, in 12 pts with melanomas and in 33 pts with breast cancer. In 199 (36.2 %) pts the number of SLNs captured on SPECT/CT was higher than on planar imaging. 35 foci of uptake (3.1 % from totally visible 1134 foci on planar images) interpreted on planar images as hot LNs were found to be false positive non-nodal sites of uptake when further assessed on SPECT/CT. Influence of the age, gender and BMI: The group of patients with higher number of detected SLN on SPECT/CT than on planar scintigraphy had lower average age than the group of patients with the same number of detected SLN on SPECT/CT and on planar scintigraphy, the difference was statistically significant (P=0.008). BMI did not differ in these two groups. There has been proportionally higher number of men than women who have had higher detected SLNs on SPECT/CT than on planar scintigrams (difference statistically significant P=0.04). It follows that gender influences the difference of detected SLNs on SPECT/CT and planar scintigraphy in favor of male gender. Conclusion:In some patients with gynecologic, including breast cancers and melanomas SPECT/CT improves detection of SLNs as compared to planar scintigraphy. It can image nodes not visible on planar scintigrams, excludes false positiv...

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Section: Introductionmentioning

confidence: 99%

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Kraft

Havel

2012

JBGC

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“…One article (25) was discarded because of an overlap in patients with an included study (8). The references cited in the remaining 8 articles were cross-checked and did not yield any additional eligible studies (3)(4)(5)8,9,(26)(27)(28).…”

Section: Literature Search and Assessmentmentioning

confidence: 99%

“…Three studies (3-5) exclusively investigated patients with cervical cancer; others did so in combination with endometrial cancer (9,26,27), vulvar cancer (28), or both (8). In total, SPECT/CT and lymphoscintigraphy were performed for 207 and 208 cervical cancer patients, respectively.…”

Section: Sln Detectionmentioning

confidence: 99%

“…Except for a single International Federation of Gynecology and Obstetrics (FIGO) Stage IIIA case from Klapdor et al (5), all these subjects had early-stage disease (FIGO stage I/II). Lymph node involvement for cervical cancer was reported in all studies except that of Kraft and Havel (8) and ranged from 0.0% to 28.6% (overall mean, 19.8%) (3)(4)(5)9,(26)(27)(28). The outlier of 0% lymph node metastasis occurred in a single study with 10 patients (26).…”

Section: Sln Detectionmentioning

confidence: 99%

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^99mTc SPECT/CT Versus Planar Lymphoscintigraphy for Preoperative Sentinel Lymph Node Detection in Cervical Cancer: A Systematic Review and Metaanalysis

et al. 2015

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We aimed to compare SPECT/CT and lymphoscintigraphy on overall and bilateral sentinel lymph node (SLN) detection in cervical cancer patients. Methods: A systematic search was performed on August 1, 2014, in PubMed, Embase, Scopus, and the Cochrane library. The syntax was based on synonyms of the terms cervical cancer, SPECT/CT, and lymphoscintigraphy. Retrieved articles were screened on their title/abstract and considered eligible when an SLN procedure was performed using both imaging modalities and if detection results were reported. Two independent reviewers assessed all included studies on methodologic quality using QUADAS-2. Studies were pooled on their odds ratios (ORs) with a randomeffects model. Results: The search yielded 962 unique articles, of which 8 were ultimately included. The studies were recent retrospective or prospective cohort studies of limited size (n 5 7-51) but sufficient methodologic quality. The median overall detection ($1 SLN in a patient) was 98.6% for SPECT/CT (range, 92.2%-100.0%) and 85.3% for lymphoscintigraphy (range, 70.0%-100.0%). This corresponded to a pooled overall SLN detection OR of 2.5 (95% CI, 1.2-5.3) in favor of SPECT/CT. The reported median bilateral detection ($1 SLN in each hemipelvis) was 69.0% for SPECT/CT (range, 62.7%-79.3%) and 66.7% for lymphoscintigraphy (range, 56.9%-75.8%), yielding a pooled OR of 1.2 (95% CI, 0.7-2.1). No significant difference in the number of visualized SLNs was observed at a pooled ratio of 1.2 (95% CI, 0.9-1.6). In recent years, the sentinel lymph node (SLN) procedure has been increasingly adopted in the staging of cervical cancer patients eligible for surgery. The SLN procedure allows for individualized treatment decisions by accurately ascertaining the lymph node status before radical surgery takes place (1), with the possibility of excluding fertility-sparing surgery or replacing a radical hysterectomy with chemoradiotherapy in patients with tumorpositive lymph nodes.Besides blue dye, the colloid-bound radionuclide 99m Tc is commonly added as a second tracer and has been shown to improve intraoperative SLN detection (2). A second advantage of this tracer is that preoperative lymphatic mapping by either SPECT/ CT or planar lymphoscintigraphy becomes possible, enabling prediction of the surgical detectability and number of SLNs in an individual patient. This ability aids the surgeon in performing a more direct SLN resection with less disruption of the lymphatic architecture when compared with a full retroperitoneal exploration (3-5).Although SPECT/CT is associated with both increased upfront cost and ionizing radiation, it provides a cross-sectional anatomic reference that allows for accurate 3-dimensional SLN localization, which is considered an important advantage over planar lymphoscintigraphy (5-9). Both SPECT/CT and lymphoscintigraphy should ideally have a high SLN detection ability, which largely determines the clinical value of the entire procedure.On the basis of a systematic search of the literature, we compared detection of ...

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“…The results to date suggest that this examination can increase the detection and improve the preoperative anatomic localization of LS, when compared to lymphoscintigraphy with Tc99. 20,21 In relation to microinvasive disease, there are no studies only with this population, the focus of interest of the present chapter. A significant part of the works with initial cases includes patients between FIGO stages IA1 and IB1.…”

Section: Lymph Nodesmentioning

confidence: 99%

Microinvasive Carcinoma of the Cervix

Anschau¹,

Marc²,

Torrens³

et al. 2012

Topics on Cervical Cancer With an Advocacy for Prevention

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Single photon emission computed tomography SPECT-CT improves sentinel node detection and localization in cervical and uterine malignancy

Cited by 79 publications

References 26 publications

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

Detection of sentinel lymph nodes by SPECT/CT and planar scintigraphy: The influence of age, gender and BMI

^99mTc SPECT/CT Versus Planar Lymphoscintigraphy for Preoperative Sentinel Lymph Node Detection in Cervical Cancer: A Systematic Review and Metaanalysis

Microinvasive Carcinoma of the Cervix

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