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SPECT/CT in imaging sentinel nodes

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Abstract

Sentinel lymph node lymphoscintigraphy and biopsy (SLNB) has become standard practice for lymphatic staging in early stage breast cancer and melanoma. SLNB has also been used in head and neck squamous cell cancers and other solid tumours. Although SPECT/CT imaging in SLNB is not currently standard practice, there is growing evidence for its use. This article reviews the role of SPECT/CT in SLNB and describes its potential advantages over planar imaging. The hybrid SPECT/CT imaging modality fuses functional and anatomical information and has advantages over SPECT/CT in certain scenarios. We did a PUBMED (MeSH) search with the following keywords: SPECT/CT, sentinel lymph node, breast cancer, melanoma, oral cavity, gynaecological, prostate, single photon tomography and reviewed relevant articles. In breast cancer, SPECT/CT may contribute to more adequate patient management in the following indications: in overweight and obese patients, in patients with non-visualisation of the lymph node on planar images and in patients with unusual drainage pattern or difficult to interpret images. The advantages of SPECT/CT in melanoma include a higher overall rate of SLN detection, the ability to detect SLNs in difficult to interpret planar studies, better detection of SLNs near an injection site and better anatomical localisation. These advantages can result in change in patient management, by altering the surgical approach. Precise localisation may also result in reduced overall cost of the sentinel node procedure. SPECT/CT also provides valuable information in head and neck cancer. SPECT/CT provides improved anatomical localisation, and increases accuracy by locating additional SLNs, identifying false negatives (close to the injection site) and false positive (skin contamination) with subsequent impact on patient management.

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Conflict of interest

Dr. Shaunak Navalkissoor, Dr. Thomas Wagner, Dr. Gopinath Gnanasegaran, Dr. John Buscombe: None.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK

    Shaunak Navalkissoor & Thomas Wagner

  2. Department of Nuclear Medicine, Guys and St. Thomas NHS Trust, London, UK

    Gopinath Gnanasegaran

  3. Department of Nuclear Medicine, Addenbrooke’s Hospital, Cambridge, UK

    John Buscombe

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  1. Shaunak Navalkissoor
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Navalkissoor, S., Wagner, T., Gnanasegaran, G. et al. SPECT/CT in imaging sentinel nodes. Clin Transl Imaging 3, 203–215 (2015). https://doi.org/10.1007/s40336-015-0113-3

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