The single-photon emission computed tomography/computed tomography: a new procedure to perform the sentinel node biopsy in patients with head and neck melanoma

Abstract

The aim of this study was to define and validate a new technique to detect the sentinel node (SN) in patients treated for head and neck melanoma. In a small series of 23 head and neck melanoma patients, lymphatic mapping was followed by SN biopsy, using in 12 patients a new diagnostic imaging technique, single-photon emission computed tomography/computed tomography. The procedure is described and the major problems encountered are discussed. The preliminary data show that identification of SN using single-photon emission computed tomography/computed tomography never failed in 12 patients, and biopsies performed, compared with those in a standard group, took significantly less time (Mann-Whitney test P=0.006). In conclusion, the authors underline the possibility of a wide use for this technique.

SPECT/CT for preoperative sentinel node localization

“…Figure 2 shows an example of a patient with complex drainage on the conventional images in whom SPECT/CT identified an additional subcutaneous sentinel node underneath the injection area. The value of SPECT/CT for lymphatic mapping of melanoma of the head and neck is underlined by Covarelli et al [34], who demonstrated that sentinel node biopsy based on SPECT/CT images took significantly less time than sentinel node biopsy based on conventional images. The authors argue that more precise preoperative localization of a sentinel node and knowledge of the relationship with anatomical structures facilitated surgical excision [34].…”

“…The value of SPECT/CT for lymphatic mapping of melanoma of the head and neck is underlined by Covarelli et al [34], who demonstrated that sentinel node biopsy based on SPECT/CT images took significantly less time than sentinel node biopsy based on conventional images. The authors argue that more precise preoperative localization of a sentinel node and knowledge of the relationship with anatomical structures facilitated surgical excision [34]. They also mention that SPECT/CT can detect sentinel nodes in spite of scattered radiation of the injection site.…”

“…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].…”

“…There are just a few case reports and cohort studies on SPECT/CT for lymphatic mapping in patients with melanoma [29][30][31][32][33][34][35] and these are listed in Table II. The investigators of the cohort studies administered four intracutaneous deposits with a total dose of 74-185 MBq (2-5 mCi) of the radiopharmaceutical.…”

“…Covarelli et al only investigated patients with a head and neck melanoma and administered 10 MBq (0.3 mCi) when patients where operated on the same day and 50 MBq (1.4 mCi) if patients were operated the next day. They performed conventional imaging in half of the patients and SPECT/CT in the other half of the patients [34]. Fig.…”