Abstract
PurposeCoregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging.MethodsSNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed.ResultsA total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB.ConclusionsThis large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.
Highlights
Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma
The analysis showed a significantly increased sentinel node positivity rate in the SPECT/CT
Our data are consistent with the previous literature in that we found a significantly increased number of sentinel lymph node(s) (SLN) and were identified by SPECT/ CT compared with LSG (Table 1)
Summary
Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. Accurate preoperative lymphoscintigraphy (LSG) is essential for successfully performing SNB.[3] there is a recognised false-negative rate associated with the technique,[4] in the head and neck region, and data from Sydney suggest that failure to visualise the SN accurately is contributory to the false-negative rate.[5] The introduction of coregistered single-photon emission computed tomography with integrated computed tomography (SPECT/CT) has greatly improved the accuracy of localisation of the sentinel lymph node(s) (SLN) prior for primary cutaneous melanoma.[6,7,8,9,10,11] At a national SNB consensus meeting, concerns were raised by the pathologists that more SLNs were being harvested since the introduction for SPECT/CT imaging, thereby impacting on workload and throughput.[12] concerns were raised by the surgeons that the increasing accuracy of SLN identification, whilst generally considered a positive benefit, was associated with increasing surgical morbidity and an increasing number of SNB procedures cancelled preoperatively. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging for SNB staging of cutaneous melanoma in a large cohort treated at an academic, tertiary referral cancer centre
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