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. Issue 5 (1st June 2012)

• Record Type: Journal Article
• Authors: Buda, Alessandro; Elisei, Federica; Arosio, Maurizio; Dolci, Carlotta; Signorelli, Mauro; Perego, Patrizia; Giuliani, Daniela; Recalcati, Dario; Cattoretti, Giorgio; Milani, Rodolfo; Messa, Cristina
• Is Part Of: International journal of gynecological cancer. Volume 22:Issue 5(2012)
• Page Start: 830
• Page End: 835
• Publication Date: 2012-06-01
• Subjects: Sentinel node detection -- Preoperative SPECT/CT -- Uterine cancer; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0b013e318253496f
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objective: The purpose of this study was to assess whether there is an additional value of single-photon emission computed tomography/computed tomography (SPECT/CT) over lymphoscintigraphy (LSG) alone for sentinel node (SN) mapping in endometrial and cervical cancer. Methods: Ten women with clinically cervical stage IA2 to stage IB1 and 25 women with stage I endometrial cancer underwent preoperative LSG for SN mapping. Technetium Tc 99m albumin nanocolloid was injected submucosally at 4 points of the cervix. Patients underwent SPECT/CT emission-transmission study at least 3 hours after standard planar images. Methylene blue was injected into the cervix just before surgery under general anesthesia. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and radical regional nodal dissection. Hot and/or blue nodes were labeled as SNs. Results: Conventional planar imaging detection rate was 50%, whereas the detection rate of at least one SN with SPECT/CT was 91% (32/35); bilateral detection was achieved in 7 (39%) of 18 women in planar and in 17 (53%) of 32 women in SPECT/CT imaging, respectively. Bilateral detection was achieved in 57% of women (20/35). Sentinel nodes were located in external and internal iliac nodes (66%), obturator nodes (5%), internal iliac nodes (11%), common iliac nodes (9%), and presacral nodes (9%). Lymph node involvement was identified in 5 patients (14%). Sentinel node correctly predicted lymph node involvement in all node-positive patients. Sentinel node sensitivity and negative predictive value of SPECT/CT were 100%. Conclusions: Single photon emission computed tomography/computed tomography seems to improve intraoperative identification of SNs and provides additional useful information about the anatomic location of SNs compared to planar LSG in cervical and endometrial cancer.