Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 1/2017

01-01-2017 | Original Article

Sentinel-node mapping in endometrial cancer patients: comparing SPECT/CT, gamma-probe and dye

Authors: Federica Elisei, Cinzia Crivellaro, Daniela Giuliani, Carlotta Dolci, Elena De Ponti, Luca Montanelli, Maria La Manna, Luca Guerra, Maurizio Arosio, Claudio Landoni, Alessandro Buda

Published in: Annals of Nuclear Medicine | Issue 1/2017

Login to get access

Abstract

Objective

The aim of this study was to compare preoperative SPECT/CT with gamma-probe and methylene blue-dye (MBD) in the identification of sentinel lymph node (SLN) in early stage endometrial cancer.

Methods

40 stage-I EC patients (66.7 ± 9.7 years) underwent preoperative lymphoscintigraphy. After about 3 h from Tc-99m-albumin nanocolloid cervical injection, all patients underwent SPECT/CT study. MBD was injected into the cervix just before surgery under general anesthesia. All patients underwent SLN biopsy, hysterectomy, bilateral salpingo-oophorectomy, and radical regional lymphadenectomy. SPECT/CT findings were compared to those of gamma-probe and MBD techniques.

Results

In 2 patients no nodal migration was observed, neither with MBD nor radiotracer. Detection rate of at least one SLN was 90% (36/40 patients) with SPECT/CT, 88% (35/40) intra-operatively with gamma-probe and 80% (32/40) with MBD. Only in 7/40 patients a bilateral migration was obtained with all considered modalities. In particular, bilateral detection was achieved in 26 patients with SPECT/CT, in 24 with gamma-probe and in 10 patients with MBD. The concordance site between SPECT/CT and intraoperative gamma-probe was 73% (29/40 patients: 2 without migration, 21 bilateral and 6 monolateral SLNs); while concordance site with MBD was found in 40% (16/40: 8 bilateral, 6 monolateral SLNs, 2 without SLNs). Overall, 628 LNs were dissected (mean 18 LNs per patient). The median number of SLNs removed was 2 (mean 2.5 per patient). Out of 91 SLNs: 43 were “hot and blue (HB)”, 10 were blue only and 38 were hot only. LN metastases rate was 16%: 9/90 SLNs (7 HB, 2 hot only) were positive for metastases in 6 patients. Four non-SLNs were found positive in 3 patients, and all presented concomitant positive SLNs. False negative rate was 0%.

Conclusions

SPECT/CT had the highest detection rate and achieved the highest rate of bilateral mapping, compared to gamma-probe and MDB. SPECT/CT had moderate concordance with gamma-probe, and it can help the intraoperative detection of SLNs providing important information about their anatomic location.
Literature
1.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.CrossRefPubMed
2.
Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.CrossRefPubMed
3.
Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–16.CrossRefPubMed
4.
Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi33–8.CrossRefPubMed
5.
May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 2010;(1):CD007585. doi:10.​1002/​14651858.
6.
Crivellaro C, Signorelli M, Guerra L, De Ponti E, Pirovano C, Fruscio R, et al. Tailoring systematic lymphadenectomy in high-risk clinical early stage endometrial cancer: the role of 18F-FDG PET/CT. Gynecol Oncol. 2013;130:306–11.CrossRefPubMed
7.
Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up dagger. Ann Oncol. 2016;27:16–41.CrossRefPubMed
8.
9.
Abu-Rustum NR. The increasing credibility of sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol. 2013;20:353–4.CrossRefPubMed
10.
Abu-Rustum NR. Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Canc Netw. 2014;12:288–97.PubMed
11.
Bats AS, Frati A, Froissart M, Orliaguet I, Querleu D, Zerdoud S, et al. Feasibility and performance of lymphoscintigraphy in sentinel lymph node biopsy for early cervical cancer: results of the prospective multicenter SENTICOL study. Ann Nucl Med. 2015;29:63–70.CrossRefPubMed
12.
Yoneyama H, Tsushima H, Onoguchi M, Konishi T, Nakajima K, Matsuo S, et al. Optimization of attenuation and scatter corrections in sentinel lymph node scintigraphy using SPECT/CT systems. Ann Nucl Med. 2015;29:248–55.CrossRefPubMed
13.
Jewell EL, Huang JJ, Abu-Rustum NR, Gardner GJ, Brown CL, Sonoda Y, et al. Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol. 2014;133:274–7.CrossRefPubMed
14.
Buda A, Crivellaro C, Elisei F, Di Martino G, Guerra L, De Ponti E, et al. Impact of indocyanine green for sentinel lymph node mapping in early stage endometrial and cervical cancer: comparison with conventional radiotracer Tc and/or blue dye. Ann Surg Oncol. 2016;23:2183–91.CrossRefPubMed
15.
Buda A, Elisei F, Arosio M, Dolci C, Signorelli M, Perego P, et al. Integration of hybrid single-photon emission computed tomography/computed tomography in the preoperative assessment of sentinel node in patients with cervical and endometrial cancer: our experience and literature review. Int J Gynecol Cancer. 2012;22:830–5.CrossRefPubMed
16.
Reiffenstuhl G. Contribution on the nomenclature of the pelvic lymph nodes. Wien Klin Wochenschr. 1956;68:247–8.PubMed
17.
St Clair CM, Eriksson AG, Ducie JA, Jewell EL, Alektiar KM, Hensley ML, et al. Low-volume lymph node metastasis discovered during sentinel lymph node mapping for endometrial carcinoma. Ann Surg Oncol. 2016;23:1653–9.CrossRefPubMed
18.
Ferraioli D, Chopin N, Beurrier F, Carrabin N, Buenerd A, Mathevet P. The incidence and clinical significance of the micrometastases in the sentinel lymph nodes during surgical staging for early endometrial cancer. Int J Gynecol Cancer. 2015;25:673–80.CrossRefPubMed
19.
Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522–7.CrossRefPubMed
20.
Perissinotti A, Paredes P, Vidal-Sicart S, Torne A, Albela S, Navales I, et al. Use of SPECT/CT for improved sentinel lymph node localization in endometrial cancer. Gynecol Oncol. 2013;129:42–8.CrossRefPubMed
21.
Ballester M, Dubernard G, Lecuru F, Heitz D, Mathevet P, Marret H, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12:469–76.CrossRefPubMed
22.
Sawicki S, Kobierski J, Lapinska-Szumczyk S, Lass P, Cytawa W, Bianek-Bodzak A, et al. Comparison of SPECT-CT results and intraoperative detection of sentinel lymph nodes in endometrial cancer. Nucl Med Commun. 2013;34:590–6.CrossRefPubMed
23.
Ballester M, Rouzier R, Coutant C, Kerrou K, Darai E. Limits of lymphoscintigraphy for sentinel node biopsy in women with endometrial cancer. Gynecol Oncol. 2009;112:348–52.CrossRefPubMed
24.
Brucker SY, Taran FA, Wallwiener D. Sentinel lymph node mapping in endometrial cancer: a concept ready for clinical routine? Arch Gynecol Obstet. 2014;290:9–11.CrossRefPubMed
25.
Buda A, Elisei F, Palazzi S, De Ponti E, Arosio M, Vecchione F, et al. Quality of care for cervical and endometrial cancer patients: the impact of different techniques of sentinel lymph node mapping on patient satisfaction. Ann Surg Oncol. 2016;23:2975–81.CrossRefPubMed
26.
Touboul C, Bentivegna E, Uzan C, Gouy S, Pautier P, Lhomme C, et al. Sentinel lymph node in endometrial cancer: a review. Curr Oncol Rep. 2013;15:559–65.CrossRefPubMed
27.
Cibula D, Oonk MH, Abu-Rustum NR. Sentinel lymph node biopsy in the management of gynecologic cancer. Curr Opin Obstet Gynecol. 2015;27:66–72.CrossRefPubMed
28.
Pandit-Taskar N, Gemignani ML, Lyall A, Larson SM, Barakat RR, Abu Rustum NR. Single photon emission computed tomography SPECT-CT improves sentinel node detection and localization in cervical and uterine malignancy. Gynecol Oncol. 2010;117:59–64.CrossRefPubMed
29.
Darin MC, Gomez-Hidalgo NR, Westin SN, Soliman PT, Escobar PF, Frumovitz M, et al. Role of indocyanine green in sentinel node mapping in gynecologic cancer: is fluorescence imaging the new standard? J Minim Invasive Gynecol. 2016;23:186–93.CrossRefPubMed
30.
Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E, et al. From conventional radiotracer Tc-99 with blue dye to indocyanine green fluorescence: a comparison of methods towards optimization of sentinel lymph node mapping in early stage cervical cancer for a laparoscopic approach. Ann Surg Oncol. 2016;23:2959–65.CrossRefPubMed
31.
Papadia A, Imboden S, Siegenthaler F, Gasparri ML, Mohr S, Lanz S, et al. Laparoscopic indocyanine green sentinel lymph node mapping in endometrial cancer. Ann Surg Oncol. 2016;23:2206–11.CrossRefPubMedPubMedCentral
32.
How J, Gotlieb WH, Press JZ, Abitbol J, Pelmus M, Ferenczy A, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015;137:436–42.CrossRefPubMed
33.
Ruscito I, Gasparri ML, Braicu EI, Bellati F, Raio L, Sehouli J, et al. Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes-a meta-analysis. Ann Surg Oncol. 2016;23:3749–56.CrossRefPubMed
34.
Devaja O, Nagar HA. Sentinel lymph node biopsy in endometrial cancer, scientific impact paper No. 51. 2016.
35.
Montgomery LL, Thorne AC, Van Zee KJ, Fey J, Heerdt AS, Gemignani M, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg. 2002;95:385–8 (table of contents).PubMed
36.
Salvatori M, Treglia G, Mores N. Further considerations on adverse reactions to radiopharmaceuticals. Eur J Nucl Med Mol Imaging. 2012;39:1360–2.CrossRefPubMed
37.
Holloway RW, Bravo RA, Rakowski JA, James JA, Jeppson CN, Ingersoll SB, et al. Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: a comparison of colorimetric and fluorescence imaging. Gynecol Oncol. 2012;126:25–9.CrossRefPubMed
Metadata
Title
Sentinel-node mapping in endometrial cancer patients: comparing SPECT/CT, gamma-probe and dye
Authors
Federica Elisei
Cinzia Crivellaro
Daniela Giuliani
Carlotta Dolci
Elena De Ponti
Luca Montanelli
Maria La Manna
Luca Guerra
Maurizio Arosio
Claudio Landoni
Alessandro Buda
Publication date
01-01-2017
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 1/2017
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-016-1137-0

Other articles of this Issue 1/2017

Annals of Nuclear Medicine 1/2017 Go to the issue

Original Article

Cost-effective initial assessment strategies for thyroid nodules in iodine-adequate areas

Original Article

Low- and high-dose radioiodine therapy for low-/intermediate-risk differentiated thyroid cancer: a preliminary clinical trial

Original Article

Synthesis and basic evaluation of 7α-(3-[18F]fluoropropyl)-testosterone and 7α-(3-[18F]fluoropropyl)-dihydrotestosterone

Original Article

Different predictive values of interim 18F-FDG PET/CT in germinal center like and non-germinal center like diffuse large B-cell lymphoma

Original Article

Prognostic value of primary tumor SUVmax on F-18 FDG PET/CT compared with semi-quantitative tumor uptake on Tc-99m sestamibi breast-specific gamma imaging in invasive ductal breast cancer

Original Article

Intratumoral heterogeneity of 18F-FLT uptake predicts proliferation and survival in patients with newly diagnosed gliomas