Precise localisation of a sentinel lymph node in a rare drainage region with SPECT/MRI using interstitial injection of ^99mTc-nanocolloid and superparamagnetic iron oxide

Excerpt

A 60-year-old man is presented with a 1-cm biopsy scar after excision of a superficial spreading melanoma (Breslow depth 0.47 mm) in the left lumbar region (T11 dermatome). Dynamic and static lymphoscintigraphy was performed as described elsewhere [1]. A highly uncommon sentinel lymph node (SLN) was revealed near the upper pole of the left kidney. No other draining lymph nodes could be located; in particular, none were seen in the axillary, inguinal or cervical regions, which are common locations in patients with truncal melanomas [2‐4]. For better localisation of the SLN we performed a SPECT study of the abdomen followed by T2-weighted MRI after interstitial injection of superparamagnetic iron oxide around the biopsy scar. Image fusion enabled precise localisation of the SLN (diameter 7 mm) in the left retrocrural region. Fused ¹⁸F-FDG PET/contrast MRI did not show any evidence of locoregional or distant metastatic disease. …