The role of SPECT-CT in the lymphoscintigraphic identification of sentinel nodes in patients with oral cancer

Bilde, Anders; Buchwald, Christian von; Mortensen, Jann; Marving, J.; Therkildsen, Marianne Hamilton; Kirkegaard, Jørgen; Charabi, Birgitte; Specht, Lena

doi:10.1080/00016480600794453

Cited by 68 publications

(60 citation statements)

References 23 publications

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“…In general, more SNs are identified by SPECT/CT than by planar lymphoscintigraphy (16)(17)(18)(19)(20). However, it may remain difficult or impossible to establish which are true SNs rather than second-echelon ones.…”

Section: Discussionmentioning

confidence: 99%

⁸⁹Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

Heuveling¹,

Visser²,

Baclayon³

et al. 2011

J Nucl Med

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Identifying sentinel nodes near the primary tumor remains a problem in, for example, head and neck cancer because of the limited resolution of current lymphoscintigraphic imaging when using 99m Tc-nanocolloidal albumin. This study describes the development and evaluation of a nanocolloidal albumin-based tracer specifically dedicated for high-resolution PET detection. Methods: 89 Zr was coupled to nanocolloidal albumin via the bifunctional chelate p-isothiocyanatobenzyldesferrioxamine B. Quality control tests, including particle size measurements, and in vivo biodistribution and imaging experiments in a rabbit lymphogenic metastasis model were performed. Results: Coupling of 89 Zr to nanocolloidal albumin appeared to be efficient, resulting in a stable product with a radiochemical purity greater than 95%, without affecting the particle size. PET showed distinguished uptake of 89 Zr-nanocolloidal albumin in the sentinel nodes, with visualization of lymphatic vessels, and with a biodistribution comparable to 99m Tc-nanocolloidal albumin. Conclusion: 89 Zr-nanocolloidal albumin is a promising tracer for sentinel node detection by PET.Key Words: sentinel node; PET/CT; 89 Zr; Nanocoll; head and neck cancer Thesent inel node (SN) procedure is applied in a variety of tumor types, including head and neck squamous cell carcinoma (HNSCC) (1,2). Although, in general, results in HNSCC are good, adequate detection of the SN in floor-ofmouth tumors, compared with other sites, appeared problematic, as illustrated by significantly lower sensitivity and negative predictive value (1). This is probably due to the short distance between the primary tumor and the first draining lymph nodes (SNs) in combination with the limited resolution of planar lymphoscintigraphy and SPECT. The injection site (around the primary tumor) produces a large focus of intense activity on planar lymphoscintigraphy, possibly hiding SNs near the primary tumor. As a result, second-echelon lymph nodes may erroneously be considered SNs; this is also true for SPECT: the added value of detecting foci hidden at planar scintigraphy may be offset by its lack of dynamic information with the typically fast kinetics of lymph drainage in HNSCC.PET provides dynamic 3-dimensional information at a higher spatial resolution than achievable with a g-camera.Theoretically, these characteristics may better differentiate between the first-and second-echelon nodes. To the best of our knowledge, no PET radiocolloids specifically dedicated to lymphatic mapping are clinically available yet. The aim of this study was to develop and evaluate in a rabbit lymphogenic metastasis model a 89 Zr (half-life, 78 h)-nanocolloidal albumin (Nanocoll; GE Healthcare)-based PET radiocolloid dedicated to SN detection. Results were compared with 99m Tc-nanocolloidal albumin ( 99m Tc half-life, 6 h). MATERIALS AND METHODSPreparation of 89 Zr-and 99m Tc-Nanocolloidal Albumin A 0.5-mg kit for the labeling of colloidal human serum albumin with 99m Tc was premodified with p-isothiocyanatobenzyldesferriox...

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Section: Discussionmentioning

confidence: 99%

⁸⁹Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

Heuveling¹,

Visser²,

Baclayon³

et al. 2011

J Nucl Med

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“…Because of complex lymph drainage systems and the presence of several vital structures such as vessels and nerves, preoperative imaging in this region is essential. Several authors have concluded that the additional use of SPECT/CT in head and neck cancer leads to detection of more sentinel nodes and better anatomic localization of the sentinel nodes (12)(13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Besides breast cancer, the use of SPECT/CT has been quite well described in sentinel node lymphadenectomy for head and neck cancer (12)(13)(14)(15)(16)(17). Because of complex lymph drainage systems and the presence of several vital structures such as vessels and nerves, preoperative imaging in this region is essential.…”

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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“…SPECT/CT has been reported to visualize additional sentinel nodes in this anatomically complex area [31,36,39,[41][42][43]. Sentinel nodes located in the vicinity of the injection site are easily missed on the conventional images and can often be discerned using SPECT/CT [36,37].…”

Section: Spect/ct In Patients With Other Malignanciesmentioning

confidence: 99%

“…Various authors describe that SPECT/CT provides useful information as to the exact location of sentinel nodes in head and neck malignancies [31,34,36,37,[39][40][41], as is exemplified in Figure 3. SPECT/CT has been reported to visualize additional sentinel nodes in this anatomically complex area [31,36,39,[41][42][43].…”

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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The role of SPECT-CT in the lymphoscintigraphic identification of sentinel nodes in patients with oral cancer

Cited by 68 publications

References 23 publications

⁸⁹Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

⁸⁹Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

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

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The role of SPECT-CT in the lymphoscintigraphic identification of sentinel nodes in patients with oral cancer

Cited by 68 publications

References 23 publications

89Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

89Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

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

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⁸⁹Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results

⁸⁹Zr-Nanocolloidal Albumin–Based PET/CT Lymphoscintigraphy for Sentinel Node Detection in Head and Neck Cancer: Preclinical Results