Amelia Jimenez-Heffernan1, Annare Ellmann2, Heitor Sado3, Dražen Huić4, Chandrasekhar Bal5, Ramanathapuram Parameswaran6, Francesco Giammarile7, Rossana Pruzzo8, Irena Kostadinova9, Mariza Vorster10, Paulo Almeida11, Jonas Santiago12, Sanjay Gambhir13, Sonya Sergieva14, Alvaro Calderon15, Gabriela Oh Young16, Renato Valdes-Olmos17, John Zaknun18, Vincent Peter Magboo19, Thomas N B Pascual20. 1. Hospital Juan Ramon Jimenez, Huelva, Spain. 2. Stellenbosch University, Tygerberg Hospital, Stellenbosch, South Africa. 3. Instituto Do Cancer de Sao Paulo, Sao Paulo, Brazil. 4. University Hospital Centre Zagreb, Zagreb, Croatia. 5. All India Institute of Medical Sciences, New Delhi, India. 6. Manipal Hospital, Bangalore, India. 7. Hospices Civils, University of Lyon 1, Lyon, France. 8. Fundacion Arturo Lopez Perez, Santiago, Chile. 9. University Hospital Alexandrovska, Sofia, Bulgaria. 10. Pretoria Academic Hospital, Pretoria, South Africa. 11. Real Hospital Português, Recife, Brazil. 12. St. Lukes Medical Center, Quezon City, Philippines. 13. Sanjay Gandhi Institute of Medical Sciences, Lucknow, India. 14. Sofia Cancer Center, Sofia, Bulgaria. 15. Instituto Nacional de Cancerlologia, Bogota, Colombia. 16. Universidade de Sao Paulo, Sao Paulo, Brazil. 17. The Netherlands Cancer Institute, Amsterdam, The Netherlands. 18. IAEA, Vienna, Austria; and. 19. University of the Philippines Manila, Manila, Philippines. 20. IAEA, Vienna, Austria; and T.Pascual@iaea.org.
Abstract
UNLABELLED: We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors. METHODS: From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day. RESULTS: Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer. CONCLUSION: SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.
UNLABELLED: We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors. METHODS: From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day. RESULTS: Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer. CONCLUSION: SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancerpatients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanomapatients with unexpected drainage on PI.
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