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The use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer: possible implications for the extent of inguinal lymph node dissection

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine the lymphatic drainage pattern using SPECT/CT in clinically node-negative (cN0) patients with vulvar cancer, and to evaluate the possible implications for the extent of inguinal lymph node dissection.

Methods

A total of 83 patients with vulvar cancer scheduled for sentinel node (SN) biopsy were injected peritumorally with radioactive nanocolloid particles followed by lymphoscintigraphy and SPECT/CT for anatomical localization. The SN and higher-echelon nodes on SPECT/CT were located in different zones in the groin and pelvic region. The groin was divided into five zones according to Daseler et al.: four zones obtained by drawing two perpendicular lines over the saphenofemoral junction and one zone directly overlying this junction. The nodes in the pelvic region were classified into three zones: external iliac/obturator, the common iliac and the paraaortic zones.

Results

A total of 217 SNs and 202 higher-echelon nodes were localized on SPECT/CT. All SNs were located in the five zones according to Daseler et al.: 149 (69 %) in the medial superior region, 31 (14 %) in the medial inferior region, 22 (10 %) in the central region, 14 (6.5 %) in the lateral superior region and only 1 (0.5 %) in the lateral inferior region. The higher-echelon nodes were located both in the groin (15 %) and in the pelvic region (85 %).

Conclusion

In patients with cN0 vulvar cancer, lymphatic drainage occurs predominantly to the medial regions of the groin. Drainage to the lateral inferior region of the groin is only incidental and in SN-positive patients this zone might be spared in subsequent extended lymph node dissection. This may lead to a decrease in the morbidity associated with this procedure. SPECT/CT is able to personalize lymphatic mapping, providing detailed information about the number and anatomical location of SNs for adequate surgical planning in the groin.

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Acknowledgments

The authors thank colleagues Bas Pouw and Susana Teixeira of the Department of Nuclear Medicine of the Netherlands Cancer Institute for their support in the collection and evaluation of clinical data.

Compliance with ethical standards

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Conflicts of interest

None.

Ethical approval

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Nuclear Medicine, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Angela Collarino, Maarten L. Donswijk, Marcel P. Stokkel & Renato A. Valdés Olmos

  2. Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168, Rome, Italy

    Angela Collarino

  3. Department of Gynaecological Oncology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Willemien J. van Driel

  4. Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Renato A. Valdés Olmos

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  1. Angela Collarino
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  2. Maarten L. Donswijk
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  3. Willemien J. van Driel
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  4. Marcel P. Stokkel
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  5. Renato A. Valdés Olmos
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Correspondence to Renato A. Valdés Olmos.

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Collarino, A., Donswijk, M.L., van Driel, W.J. et al. The use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer: possible implications for the extent of inguinal lymph node dissection. Eur J Nucl Med Mol Imaging 42, 2064–2071 (2015). https://doi.org/10.1007/s00259-015-3127-1

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  • DOI: https://doi.org/10.1007/s00259-015-3127-1

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