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SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma

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

Abstract

Background

Planar lymphoscintigraphy (PL) has a lower detection rate of sentinel lymph nodes (SLNs) in head and neck melanoma compared with other sites. We assessed situations when single-photon emission computed tomography/computed tomography (SPECT/CT) identified nodes not seen by PL. We also evaluated the impact of SPECT/CT on surgical approach and oncologic outcomes.

Methods

Patients who underwent SLN biopsy (SLNB) for head and neck melanoma with PL and SPECT/CT between November 2011 and December 2016 were included. Surgeons and radiologists completed a real-time survey inquiring about the utility of SPECT/CT. Patients were divided into two groups: patients with nodal basins identified by both PL and SPECT/CT (‘PL + SPECT/CT’), and patients in whom SPECT/CT identified additional nodal basins not seen on PL (‘SPECT/CT only’). Patient demographics and long-term outcomes including follow-up duration, recurrence, and survival are described.

Results

In the PL + SPECT/CT group, 73 (61.9%) patients were included and 45 (38.1%) patients were included in the SPECT/CT-only group. SPECT/CT added 51 basins to those seen on PL, primarily in the supraclavicular region (43.1%). Eighteen patients had positive node(s) in the PL + SPECT/CT group compared with two patients in the SPECT/CT-only group. Surgeons reported that 81% of the time, SPECT/CT influenced the location of incision for SLNB.

Conclusions

SPECT/CT influences the location of incision and contributes most to identification of nodes in the supraclavicular region. It also detects additional SLN basins when compared with PL. Further studies are necessary to determine when these additional basins require sampling.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure

Becky B. Trinh, Brandon C. Chapman, Ana Gleisner, Jennifer J. Kwak, Rustain Morgan, Martin D. McCarter, Csaba Gajdos, and Nicole Kounalakis declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Becky B. Trinh MD, Brandon C. Chapman MD, Ana Gleisner MD, PhD, Martin D. McCarter MD, Csaba Gajdos MD & Nicole Kounalakis MD

  2. Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA

    Jennifer J. Kwak MD & Rustain Morgan MD

Authors
  1. Becky B. Trinh MD
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  2. Brandon C. Chapman MD
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  3. Ana Gleisner MD, PhD
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  4. Jennifer J. Kwak MD
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  5. Rustain Morgan MD
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  6. Martin D. McCarter MD
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  7. Csaba Gajdos MD
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  8. Nicole Kounalakis MD
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Corresponding author

Correspondence to Nicole Kounalakis MD.

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Trinh, B.B., Chapman, B.C., Gleisner, A. et al. SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma. Ann Surg Oncol 25, 1716–1722 (2018). https://doi.org/10.1245/s10434-017-6298-0

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  • DOI: https://doi.org/10.1245/s10434-017-6298-0

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