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Sentinel-node mapping in endometrial cancer patients: comparing SPECT/CT, gamma-probe and dye

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Abstract

Objective

The aim of this study was to compare preoperative SPECT/CT with gamma-probe and methylene blue-dye (MBD) in the identification of sentinel lymph node (SLN) in early stage endometrial cancer.

Methods

40 stage-I EC patients (66.7 ± 9.7 years) underwent preoperative lymphoscintigraphy. After about 3 h from Tc-99m-albumin nanocolloid cervical injection, all patients underwent SPECT/CT study. MBD was injected into the cervix just before surgery under general anesthesia. All patients underwent SLN biopsy, hysterectomy, bilateral salpingo-oophorectomy, and radical regional lymphadenectomy. SPECT/CT findings were compared to those of gamma-probe and MBD techniques.

Results

In 2 patients no nodal migration was observed, neither with MBD nor radiotracer. Detection rate of at least one SLN was 90% (36/40 patients) with SPECT/CT, 88% (35/40) intra-operatively with gamma-probe and 80% (32/40) with MBD. Only in 7/40 patients a bilateral migration was obtained with all considered modalities. In particular, bilateral detection was achieved in 26 patients with SPECT/CT, in 24 with gamma-probe and in 10 patients with MBD. The concordance site between SPECT/CT and intraoperative gamma-probe was 73% (29/40 patients: 2 without migration, 21 bilateral and 6 monolateral SLNs); while concordance site with MBD was found in 40% (16/40: 8 bilateral, 6 monolateral SLNs, 2 without SLNs). Overall, 628 LNs were dissected (mean 18 LNs per patient). The median number of SLNs removed was 2 (mean 2.5 per patient). Out of 91 SLNs: 43 were “hot and blue (HB)”, 10 were blue only and 38 were hot only. LN metastases rate was 16%: 9/90 SLNs (7 HB, 2 hot only) were positive for metastases in 6 patients. Four non-SLNs were found positive in 3 patients, and all presented concomitant positive SLNs. False negative rate was 0%.

Conclusions

SPECT/CT had the highest detection rate and achieved the highest rate of bilateral mapping, compared to gamma-probe and MDB. SPECT/CT had moderate concordance with gamma-probe, and it can help the intraoperative detection of SLNs providing important information about their anatomic location.

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Acknowledgements

No potential conflicts of interest were disclosed for any authors.

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Authors and Affiliations

  1. Department of Nuclear Medicine, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy

    Federica Elisei, Cinzia Crivellaro, Luca Guerra, Maurizio Arosio & Claudio Landoni

  2. School of Medicine and Surgery, University Milan-Bicocca, Milan, Italy

    Cinzia Crivellaro & Claudio Landoni

  3. Department of Obstetrics and Gynecology, ASST Monza, Monza, Italy

    Daniela Giuliani, Luca Montanelli, Maria La Manna & Alessandro Buda

  4. Tecnomed Foundation, University Milan-Bicocca, Milan, Italy

    Carlotta Dolci

  5. Department of Medical Physics, ASST Monza, Monza, Italy

    Elena De Ponti

Authors
  1. Federica Elisei
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  2. Cinzia Crivellaro
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  3. Daniela Giuliani
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  4. Carlotta Dolci
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Correspondence to Cinzia Crivellaro.

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Elisei, F., Crivellaro, C., Giuliani, D. et al. Sentinel-node mapping in endometrial cancer patients: comparing SPECT/CT, gamma-probe and dye. Ann Nucl Med 31, 93–99 (2017). https://doi.org/10.1007/s12149-016-1137-0

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  • DOI: https://doi.org/10.1007/s12149-016-1137-0

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