Comparison of SPECT-CT with intraoperative mapping in cervical and uterine malignancies. Issue 5 (1st March 2021)

• Record Type: Journal Article
• Authors: Navarro, Anne-Sophie; Angeles, Martina Aida; Migliorelli, Federico; Illac, Claire; Martínez-Gómez, Carlos; Leray, Hélène; Betrian, Sarah; Chantalat, Elodie; Tanguy Le Gac, Yann; Motton, Stephanie; Querleu, Denis; Ferron, Gwenael; Gabiache, Erwan; Martinez, Alejandra
• Is Part Of: International journal of gynecological cancer. Volume 31:Issue 5(2021)
• Page Start: 679
• Page End: 685
• Publication Date: 2021-03-01
• Subjects: Endometrium -- Cervical Cancer -- Sentinel Lymph Node -- Surgical Oncology; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1136/ijgc-2020-002198
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Introduction: The objective was to evaluate whether hybrid imaging combining single photon emission tomography with computed tomography (SPECT/CT) provides additional clinical value for dectection of sentinel lymph nodes (SLNs) compared with intraoperative combined mapping in uterine and cervical malignancies. Methods: This was a retrospective study of prospectively collected data from patients with stages IA–IB2 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2018) or stage I endometrial cancer, who underwent preoperative SPECT/CT for SLN detection. All included patients had dual injection of technetium-99m ( 99m Tc) with patent blue or indocyanine green. Results: A total of 171 patients were included with 468 SLNs detected during surgery: 146/171 patients (85.4%) had both radiotracer and blue injection whereas 25/171 patients (14.6%) had radiotracer and indocyanine green injected. The overall detection rate was 95.3%. The detection rate of SLN mapping was 74.9% for SPECT/CT, 90.6% for 99m Tc, 91.8% for blue dye, and 100% for indocyanine green. Bilateral drainage was found in 140 patients (81.9%), detected by 99m Tc in 105 patients (61.4%), by blue in 99 patients (67.3%), by indocyanine green in 23 patients (92%), and by SPECT/CT in 62 patients (36.4%). Atypical SLN locations were identified by SPECT/CT in 64 patients (37.4%), by 99mTc in 28 patients (16.4%), by blue in 17 patients (9.9%), and by indocyanine green in 8 patients (4.7%). Sensitivity and negative predictive value of SLN biopsy to detect lymph node metastasis using dual injection of different intraoperative combined techniques were 88.9% and 97.5%, respectively. Conclusion: SPECT/CT enhanced topographic delineation of SLN and more accurately identified drainage to atypical locations. Fluorescent SLN mapping using indocyanine green offered the highest SLN detection rate. When indocyanine green was used, SPECT/CT did not increase SLN detection, and did not add further information to improve lymph node localization and removal.