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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2018

01-06-2018 | Melanomas

SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma

Authors: Becky B. Trinh, MD, Brandon C. Chapman, MD, Ana Gleisner, MD, PhD, Jennifer J. Kwak, MD, Rustain Morgan, MD, Martin D. McCarter, MD, Csaba Gajdos, MD, Nicole Kounalakis, MD

Published in: Annals of Surgical Oncology | Issue 6/2018

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Abstract

Background

Planar lymphoscintigraphy (PL) has a lower detection rate of sentinel lymph nodes (SLNs) in head and neck melanoma compared with other sites. We assessed situations when single-photon emission computed tomography/computed tomography (SPECT/CT) identified nodes not seen by PL. We also evaluated the impact of SPECT/CT on surgical approach and oncologic outcomes.

Methods

Patients who underwent SLN biopsy (SLNB) for head and neck melanoma with PL and SPECT/CT between November 2011 and December 2016 were included. Surgeons and radiologists completed a real-time survey inquiring about the utility of SPECT/CT. Patients were divided into two groups: patients with nodal basins identified by both PL and SPECT/CT (‘PL + SPECT/CT’), and patients in whom SPECT/CT identified additional nodal basins not seen on PL (‘SPECT/CT only’). Patient demographics and long-term outcomes including follow-up duration, recurrence, and survival are described.

Results

In the PL + SPECT/CT group, 73 (61.9%) patients were included and 45 (38.1%) patients were included in the SPECT/CT-only group. SPECT/CT added 51 basins to those seen on PL, primarily in the supraclavicular region (43.1%). Eighteen patients had positive node(s) in the PL + SPECT/CT group compared with two patients in the SPECT/CT-only group. Surgeons reported that 81% of the time, SPECT/CT influenced the location of incision for SLNB.

Conclusions

SPECT/CT influences the location of incision and contributes most to identification of nodes in the supraclavicular region. It also detects additional SLN basins when compared with PL. Further studies are necessary to determine when these additional basins require sampling.
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Metadata
Title
SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma
Authors
Becky B. Trinh, MD
Brandon C. Chapman, MD
Ana Gleisner, MD, PhD
Jennifer J. Kwak, MD
Rustain Morgan, MD
Martin D. McCarter, MD
Csaba Gajdos, MD
Nicole Kounalakis, MD
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6298-0

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