Abstract
Objective: Assess the role of planar lymphoscintigraphy and fusion imaging of SPECT/CT in sentinel lymph node (SLN) detection in patients with gynecologic tumours.Material and Methods: Planar scintigraphy and hybrid modality SPECT/CT were performed in 64 consecutive women with gynecologic tumours (mean age 53.6 with range 30-77 years): 36 pts with cervical cancer (Group A), 21 pts with endometrial cancer (Group B), 7 pts with vulvar carcinoma (Group C). Planar and SPECT/CT images were interpreted separately by two nuclear medicine physicians. Efficacy of these two techniques to image SLN were compared.Results: Planar scintigraphy did not image SLN in 7 patients (10.9%), SPECT/CT was negative in 4 patients (6.3%). In 35 (54.7%) patients the number of SLNs captured on SPECT/CT was higher than on planar imaging. Differences in detection of SLN between planar and SPECT/CT imaging in the group of all 64 patients are statistically significant (p<0.05). Three foci of uptake (1.7% from totally visible 177 foci on planar images) in 2 patients interpreted on planar images as hot LNs were found to be false positive non-nodal sites of uptake when further assessed on SPECT/CT. SPECT/CT showed the exact anatomical location of all visualised sentinel nodes. Conclusion: In some patients with gynecologic cancers SPECT/CT improves detection of sentinel lymph nodes. It can image nodes not visible on planar scintigrams, exclude false positive uptake and exactly localise pelvic and paraaortal SLNs. It improves anatomic localization of SLNs. Conflict of interest:None declared.
Highlights
sentinel lymph node (SLN) has been incorporated in the routine management of various solid tumor types [1,2,3]
Three foci of uptake in 2 patients interpreted on planar images as hot LNs were found to be false positive nonnodal sites of uptake when further assessed on SPECT/computed tomography (CT) (1.7% from totally visible 177 foci on planar images)
One SLN with micrometastasis was detected by SPECT/CT and not by planar lymphoscintigraphy, i.e. only one node identified only on SPECT/CT was positive for tumour
Summary
SLN has been incorporated in the routine management of various solid tumor types [1,2,3]. Lymph node status in gynecologic tumours remains a most important prognostic factor for recurrence and survival and a major decision criterion for adjuvant therapy [4,5]. Despite improvements in imaging techniques, preoperative assessment of pelvic and paraaortic lymph node status remains difficult [6]. SLN biopsy is the most accurate and the only reliable method for nodal staging which can diagnose microscopic tumour spread to the regional lymph nodes. A group of patients who might benefit from a SLN biopsy are those with cancer of the uterine cervix and other gynecological malignancies. Regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy [12]. The reliability of staging can be improved by laparoscopic staging and new imaging techniques such as PET/CT. In our study we compare hybrid SPECT/CT and planar lymphoscintigraphy in patients with gynecologic tumours
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