SPECT/CT and sentinel node lymphoscintigraphy

Abstract

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.

Comparison of Single-Photon Emission Computed Tomography–Computed Tomography (SPECT/CT) and Conventional Planar Lymphoscintigraphy for Sentinel Node Localization in Patients with Cutaneous Malignancies

“…The potential benefit of improved localization of SLNs, especially in the head and neck region, has been demonstrated in previous studies. 10–12, 15,16 The purpose of our study was to determine what additional information was elucidated by the addition of SPECT/CT to PLS in patients with cutaneous malignancies.…”

“…1, 9, 10 Stoffels et al reported on the potential advantages of SPECT/CT in a retrospective study comparing 403 patients with clinically negative lymph nodes who had a SPECT/CT and PLS or PLS alone over an 8-year period. Both cohorts had similar tumor thickness, tumor ulceration, and age; however, the SPECT/CT cohort had significantly more tumors located on the head and neck.…”

Preoperative detection of sentinel lymph node in patients with endometrial cancer — comparison of planar lymphoscintigraphy, spect and SPECT/CT

“…Conventional planar lymphoscintigraphy (PL), through dynamic and static imaging in multiple positions, provides a two-dimensional display of lymphatic drainage and the SLN. Single-photon emission computed tomography (SPECT) through the acquisition of multiple cross-sections, allows obtaining a three-dimensional image which increases the sensitivity, and in combination with computed tomography as hybrid SPECT/CT technology provides more accurate anatomical localization of the SLN [9][10][11]. Identification of the SLN leads to its simpler and faster detection, and also to a reduction in the extent of surgery.…”

Radioguided Surgery: Novel Applications

“…Lymph nodes appearing between the injection site and a first draining node or nodes with increasing uptake appearing in other lymph node basin may be considered as SLN with a high probability. Higher-echelon lymph nodes in the trunk and extremities or lower-echelon nodes in the head and neck region may be included in the low-probability SLN category [35].…”