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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2017

01-02-2017 | Melanomas

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

Authors: Matthew P. Doepker, MD, Maki Yamamoto, MD, Matthew A. Applebaum, MS, Nupur U. Patel, MS, M. Jaime Montilla-Soler, MD, Amod A. Sarnaik, MD, C. Wayne Cruse, MD, Vernon K. Sondak, MD, Jonathan S. Zager, MD, FACS

Published in: Annals of Surgical Oncology | Issue 2/2017

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ABSTRACT

Background

Accurate preoperative lymphoscintigraphy is vital to performing sentinel lymph node biopsy (SLNB) for cutaneous malignancies. Potential advantages of single-photon emission computed tomography with integrated computed tomography (SPECT/CT) include the ability to readily identify aberrant drainage patterns as well as provide the surgeon with three-dimensional anatomic landmarks not seen on conventional planar lymphoscintigraphy (PLS).

Methods

Patients with cutaneous malignancies who underwent SLNB with preoperative imaging using both SPECT/CT and PLS from 2011 to 2014 were identified.

Results

Both SPECT/CT and PLS were obtained in 351 patients (median age, 69 years; range, 5–94 years) with cutaneous malignancies (melanoma = 300, Merkel cell carcinoma = 33, squamous cell carcinoma = 8, other = 10) after intradermal injection of 99mtechnetium sulfur colloid (median dose 300 µCi). A mean of 4.3 hot spots were identified on SPECT/CT compared to 3.0 on PLS (p < 0.001). One hundred fifty-three patients (43.6 %) had identical findings between SPECT/CT and PLS, while 172 (49 %) had additional hot spots identified on SPECT/CT compared to only 24 (6.8 %) additional on PLS. SPECT/CT demonstrated additional nodal basins in 103 patients (29.4 %), compared to only 11 patients (3.1 %) with additional basins on PLS.

Conclusions

SPECT/CT is a useful adjunct that can help with sentinel node localization in challenging cases. It identified additional hot spots not seen on PLS in almost 50 % of patients. Because PLS identified hot spots not seen on SPECT/CT in 6.8 % of patients, we recommend using both modalities jointly. Long-term follow-up will be required to validate the clinical significance of the additional hot spots identified by SPECT/CT.
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Metadata
Title
Comparison of Single-Photon Emission Computed Tomography–Computed Tomography (SPECT/CT) and Conventional Planar Lymphoscintigraphy for Sentinel Node Localization in Patients with Cutaneous Malignancies
Authors
Matthew P. Doepker, MD
Maki Yamamoto, MD
Matthew A. Applebaum, MS
Nupur U. Patel, MS
M. Jaime Montilla-Soler, MD
Amod A. Sarnaik, MD
C. Wayne Cruse, MD
Vernon K. Sondak, MD
Jonathan S. Zager, MD, FACS
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5590-8

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