Abstract
PurposeCurrently, most centres use 2-D planar lymphoscintigraphy when performing dynamic sentinel lymph node biopsy in penile cancer patients with clinically impalpable inguinal nodes. This study aimed to investigate the role of SPECT/CT following 2-D planar lymphoscintigraphy (dynamic and static) in the detection and localization of sentinel lymph nodes in the groin.MethodsA qualitative (visual) review was performed on planar followed by SPECT/CT lymphoscintigraphy in 115 consecutive patients (age 28–86 years) who underwent injection of 99mTc-nanocolloid followed by immediate acquisition of dynamic (20 min) and early static scans (5 min) initially and further delayed static (5 min) images at 120 min followed by SPECT/CT imaging. The lymph nodes detected in each groin on planar lymphoscintigraphy and SPECT/CT were compared.ResultsA total of 440 and 467 nodes were identified on planar scintigraphy and SPECT/CT, respectively. Overall, SPECT/CT confirmed the findings of planar imaging in 28/115 cases (24%). In the remaining 87 cases (76%), gross discrepancies were observed between planar and SPECT/CT images. SPECT/CT identified 17 instances of skin contamination (16 patients, 13%) and 36 instances of in-transit lymphatic tract activity (24 patients, 20%) that had been interpreted as tracer-avid lymph nodes on planar imaging. In addition, SPECT/CT identified 53 tracer-avid nodes in 48 patients (42%) that were not visualized on planar imaging and led to reclassification of the drainage basins (pelvic/inguinal) of 27 tracer-avid nodes.ConclusionsThe addition of SPECT/CT improved the rate of detection of true tracer-avid lymph nodes and delineated their precise (3-D) anatomic localization in drainage basins.
Highlights
Penile cancer is a rare malignancy in Western Europe and North America
The addition of single-photon emission computed tomography (SPECT)/computed tomography (CT) improved the rate of detection of true tracer-avid lymph nodes and delineated their precise (3-D) anatomic localization in drainage basins
SPECT/CT was performed after conventional planar lymphoscintigraphy in order to establish whether this imaging modality identified additional lymph nodes, allowed better delineation of the position of the sentinel lymph nodes relative to adjacent structures, detected lymphatic channels falsely identified as the sentinel lymph node, and allowed assessment of mis-localization secondary to scatter
Summary
Penile cancer is a rare malignancy in Western Europe and North America. Penile cancer has a characteristic stepwise lymphatic dissemination pattern, first to the inguinal lymph nodes and to the pelvic lymph nodes. The single most important prognostic indicator is the presence of metastatic disease in the inguinal lymph nodes. Metastatic disease in a single inguinal lymph node is associated with a 5-year survival rate of over 80%. If the number of metastatic inguinal lymph nodes exceeds two, the 5-year survival rate is reduced to 40% [3]. Since only 15–20% of clinically impalpable inguinal nodes (cN0) harbour metastatic disease, performing a radical inguinal lymphadenectomy in all of these patients would result in a high risk of overtreatment [4]. The concept of sentinel lymph node biopsy
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