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Comparison of Single-Photon Emission Computed Tomography–Computed Tomography (SPECT/CT) and Conventional Planar Lymphoscintigraphy for Sentinel Node Localization in Patients with Cutaneous Malignancies

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

Accurate preoperative lymphoscintigraphy is vital to performing sentinel lymph node biopsy (SLNB) for cutaneous malignancies. Potential advantages of single-photon emission computed tomography with integrated computed tomography (SPECT/CT) include the ability to readily identify aberrant drainage patterns as well as provide the surgeon with three-dimensional anatomic landmarks not seen on conventional planar lymphoscintigraphy (PLS).

Methods

Patients with cutaneous malignancies who underwent SLNB with preoperative imaging using both SPECT/CT and PLS from 2011 to 2014 were identified.

Results

Both SPECT/CT and PLS were obtained in 351 patients (median age, 69 years; range, 5–94 years) with cutaneous malignancies (melanoma = 300, Merkel cell carcinoma = 33, squamous cell carcinoma = 8, other = 10) after intradermal injection of 99mtechnetium sulfur colloid (median dose 300 µCi). A mean of 4.3 hot spots were identified on SPECT/CT compared to 3.0 on PLS (p < 0.001). One hundred fifty-three patients (43.6 %) had identical findings between SPECT/CT and PLS, while 172 (49 %) had additional hot spots identified on SPECT/CT compared to only 24 (6.8 %) additional on PLS. SPECT/CT demonstrated additional nodal basins in 103 patients (29.4 %), compared to only 11 patients (3.1 %) with additional basins on PLS.

Conclusions

SPECT/CT is a useful adjunct that can help with sentinel node localization in challenging cases. It identified additional hot spots not seen on PLS in almost 50 % of patients. Because PLS identified hot spots not seen on SPECT/CT in 6.8 % of patients, we recommend using both modalities jointly. Long-term follow-up will be required to validate the clinical significance of the additional hot spots identified by SPECT/CT.

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Disclosure

Jonathan S. Zager, MD: consulting fees from Amgen, Castle Biosciences, Provectus; research support from Amgen, Castle Biosciences, Provectus, and Delcath; advisory board for Delcath. Maki Yamamoto, MD: consulting fees from Castle Biosciences. Vernon K. Sondak, MD: consulting fees from Amgen, Bristol-Myers Squibb, Genentech, Merck, Novartis, and Provectus. The other authors declare no conflict of interest.

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    Authors and Affiliations

    1. Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA

      Matthew P. Doepker MD, Matthew A. Applebaum MS, Nupur U. Patel MS, Amod A. Sarnaik MD, C. Wayne Cruse MD, Vernon K. Sondak MD & Jonathan S. Zager MD, FACS

    2. Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA

      Maki Yamamoto MD

    3. Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA

      M. Jaime Montilla-Soler MD

    Authors
    1. Matthew P. Doepker MD
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    2. Maki Yamamoto MD
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    3. Matthew A. Applebaum MS
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    4. Nupur U. Patel MS
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    5. M. Jaime Montilla-Soler MD
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    6. Amod A. Sarnaik MD
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    7. C. Wayne Cruse MD
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    8. Vernon K. Sondak MD
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    9. Jonathan S. Zager MD, FACS
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    Corresponding author

    Correspondence to Jonathan S. Zager MD, FACS.

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    Vernon K. Sondak and Jonathan S. Zager have contributed equally to this article, and both should be considered senior author.

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    Doepker, M.P., Yamamoto, M., Applebaum, M.A. et al. Comparison of Single-Photon Emission Computed Tomography–Computed Tomography (SPECT/CT) and Conventional Planar Lymphoscintigraphy for Sentinel Node Localization in Patients with Cutaneous Malignancies. Ann Surg Oncol 24, 355–361 (2017). https://doi.org/10.1245/s10434-016-5590-8

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    • DOI: https://doi.org/10.1245/s10434-016-5590-8

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