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Fastner S, Creveling P, Shen N, Horns JJ, Bowles TL, Hyngstrom J, Asare EA. Single-Photon Emission Computed Tomography/Computed Tomography Utilization for Extremity Melanomas at a High-Volume Center. J Surg Res 2024; 296:196-202. [PMID: 38277957 DOI: 10.1016/j.jss.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Planar lymphoscintigraphy (PL) is commonly used in mapping before sentinel lymph node biopsy (SLNB) for invasive cutaneous melanoma. Recently, single-photon emission computed tomography (SPECT)/ computed tomography (CT) has been utilized, in addition to PL, for detailed anatomic information and detection of sentinel lymph nodes (SLNs) outside of the primary nodal basin in truncal and head and neck melanoma. Following a protocol change due to COVID-19, our institution began routinely obtaining both PL and SPECT-CT imaging for all melanoma SLN mapping. We hypothesized that SPECT-CT is associated with higher instances of SLNBs from "nontraditional" nodal basins (NTNB) for extremity melanomas. METHODS Patients with extremity melanoma (2017-2022) who underwent SLNB were grouped into SPECT-CT with PL versus PL alone. Outcomes were total SLNs removed, + or-SLN status, total NTNB sampled, and postoperative complication rate. Poisson regression and logistic regression models were used to assess association of SPECT-CT with patient outcomes. RESULTS Of 380 patients with extremity melanoma, 42.11% had SPECT-CT. There were no differences between the groups with regards to age at diagnosis or sex. From 2020 to 2022, all patients underwent SPECT-CT. SPECT-CT was associated with increased odds of SLNB from an NTNB, (odds ratio = 2.39 [95% confidence interval: 1.25-4.67]). There was no difference in odds of number of SLNs sampled, SLN positivity rate, or postoperative complication rate with SPECT-CT. CONCLUSIONS Routine SPECT-CT was associated with higher incidence of SLNB in NTNB but did not increase number of SLNs removed or SLN positivity rate. The added value of routine SPECT-CT in cutaneous melanoma of the extremities remains to be defined.
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Affiliation(s)
| | - Polly Creveling
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
| | - Nathan Shen
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Joshua J Horns
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Tawnya L Bowles
- Department of Surgery, Intermountain Medical Center, Murray, Utah
| | - John Hyngstrom
- Huntsman Cancer Institute, Salt Lake City, Utah; Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Elliot A Asare
- Huntsman Cancer Institute, Salt Lake City, Utah; Department of Surgery, University of Utah, Salt Lake City, Utah.
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Vreeburg MTA, Donswijk ML, Albersen M, Parnham A, Ayres B, Protzel C, Pettaway C, Spiess PE, Brouwer OR. New EAU/ASCO guideline recommendations on sentinel node biopsy for penile cancer and remaining challenges from a nuclear medicine perspective. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-023-06586-6. [PMID: 38216778 DOI: 10.1007/s00259-023-06586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION The European Association of Urology (EAU) and the American Society of Clinical Oncology (ASCO) recently issued updated guidelines on penile cancer, emphasising dynamic sentinel node biopsy (DSNB) as the preferred method for surgical staging among patients with invasive penile tumours and no palpable inguinal lymphadenopathy. This paper outlines the rationale behind this new recommendation and describes remaining challenges, as well as strategies for promoting DSNB worldwide. MAIN TEXT DSNB offers high diagnostic accuracy with the lowest postoperative complications compared to open or minimally invasive inguinal lymph node dissection (ILND), prompting its preference in the new guidelines. Nevertheless, despite its advantages, there are challenges hampering the widespread adoption of DSNB. This includes the false-negative rate associated with DSNB and the potential negative impact on patient outcome. To address this issue, improvements should be made in several areas, including refining the timing and interpretation of the lymphoscintigraphy and the single photon emission computed tomography/computed tomography images. In addition, the quantity of tracer employed and choice of the injection site for the radiopharmaceutical should be optimised. Finally, limiting the removal of nodes without tracer activity during surgery may help minimise complication rates. CONCLUSION Over the years, DSNB has evolved significantly, related to the dedicated efforts and innovations in nuclear medicine and subsequent clinical studies validating its efficacy. It is now strongly recommended for surgical staging among selected penile cancer patients. To optimise DSNB further, multidisciplinary collaborative research is required to improve SN identification for better diagnostic accuracy and fewer complications.
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Affiliation(s)
- Manon T A Vreeburg
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Arie Parnham
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Benjamin Ayres
- Penile Cancer Centre, St George's University Hospitals NHS Trust, London, UK
| | - Chris Protzel
- Department of Urology, University Hospital of Rostock, Rostock, Germany
| | - Curtis Pettaway
- Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | | | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, Amsterdam, The Netherlands.
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Garau LM, Di Gregorio F, Nonne G, Volterrani D, Manca G. Measures of performance for sentinel lymph node biopsy in oro-oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis. Clin Transl Imaging 2023. [DOI: 10.1007/s40336-023-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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4
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Dobre EG, Surcel M, Constantin C, Ilie MA, Caruntu A, Caruntu C, Neagu M. Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts. Int J Mol Sci 2023; 24:ijms24021079. [PMID: 36674595 PMCID: PMC9866322 DOI: 10.3390/ijms24021079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
Early diagnosis is essential for completely eradicating skin cancer and maximizing patients' clinical benefits. Emerging optical imaging modalities such as reflectance confocal microscopy (RCM), optical coherence tomography (OCT), magnetic resonance imaging (MRI), near-infrared (NIR) bioimaging, positron emission tomography (PET), and their combinations provide non-invasive imaging data that may help in the early detection of cutaneous tumors and surgical planning. Hence, they seem appropriate for observing dynamic processes such as blood flow, immune cell activation, and tumor energy metabolism, which may be relevant for disease evolution. This review discusses the latest technological and methodological advances in imaging techniques that may be applied for skin cancer detection and monitoring. In the first instance, we will describe the principle and prospective clinical applications of the most commonly used imaging techniques, highlighting the challenges and opportunities of their implementation in the clinical setting. We will also highlight how imaging techniques may complement the molecular and histological approaches in sharpening the non-invasive skin characterization, laying the ground for more personalized approaches in skin cancer patients.
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Affiliation(s)
- Elena-Georgiana Dobre
- Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095 Bucharest, Romania
| | - Mihaela Surcel
- Immunology Department, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania
| | - Carolina Constantin
- Immunology Department, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | | | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
- Correspondence:
| | - Monica Neagu
- Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095 Bucharest, Romania
- Immunology Department, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
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99mTc-labeled colloid SPECT/CT versus planar lymphoscintigraphy for sentinel lymph node detection in patients with breast cancer: a meta-analysis. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
The aim of this meta-analysis was to compare single-photon emission computed tomography (SPECT/CT) and planar lymphoscintigraphy (PL) in patients with primary breast cancer, undergoing lymphoscintigraphy at initial staging. Specifically, we assessed the detection rate (DR) for sentinel lymph node (SLN), the absolute number of detected SLNs by each technique, and the proportion of patients with additional SLNs detected by one technique compared to the other one. Finally, we aimed to evaluate the impact of SPECT/CT on the surgical approach.
Methods
Original articles, providing a head-to-head comparison between SPECT/CT and PL, including patients with primary breast cancer at first presentation, were searched in PubMed/MEDLINE and Scopus databases through March 31st, 2022. The DR of the imaging techniques was calculated on a per-patient analysis; studies were pooled on their odds ratios (ORs) with a random-effects model to assess the presence of a significant difference between the DRs of SPECT/CT and PL. The number of additional SLNs, calculated as relative risk (RR), and the pooled proportion of patients with additional SLNs using one imaging technique rather than the other one were investigated. The pooled ratio of surgical procedures (SLN harvesting) influenced by the use of SPECT/CT, according to the surgeons, was calculated.
Results
Sixteen studies with 2693 patients were eligible for the calculation of the DR of SPECT/CT and PL. The DR was 92.11% [95% confidence interval (95% CI) 89.32–94.50%] for SPECT/CT, and 85.12% (95% CI 80.58–89.15%) for PL, with an OR of 1.96 (95% CI 1.51–2.55) in favor of SPECT/CT. There was a relative risk of detection of larger number of SLNs (RR: 1.22, 95% CI 1.14–1.32; 12 studies; 979 patients) for SPECT/CT (n = 3983) compared to PL (n = 3321) and a significant proportion of patients with additional SLNs detected by SPECT/CT, which were missed by PL (18.88%, 95% CI: 11.72%-27.27%; 13 studies). Four articles, with a total number of 1427 patients, revealed that 23.98% of the surgical procedures benefited from the use of SPECT/CT.
Conclusions
This meta-analysis favors SPECT/CT over PL for the identification of SLN in patients with primary breast cancer at staging due to higher DR, more SLNs depicted, and a significant proportion of subjects with additional detected SLNs by SPECT/CT compared to PL. Furthermore, SPECT/CT positively influences the surgical procedure. However, PL remains a satisfactory imaging option for imaging departments not equipped with SPECT/CT due to its good patient-based DR.
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Noorbakhsh S, Papageorge M, Maina RM, Baumann R, Moores C, Weiss SA, Pucar D, Ariyan S, Olino K, Clune J. Methods of Sentinel Lymph Node Identification in Auricular Melanoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e4004. [PMID: 34938645 PMCID: PMC8687720 DOI: 10.1097/gox.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022]
Abstract
Sentinel lymph node biopsy is used to evaluate for micrometastasis in auricular melanoma. However, lymphatic drainage patterns of the ear are not well defined and predicting the location of sentinel nodes can be difficult. The goal of this study was to define the lymphatic drainage patterns of the ear and to compare multiple modalities of sentinel node identification. METHODS A retrospective review of a prospectively maintained database evaluated 80 patients with auricular melanoma who underwent sentinel lymph node biopsy by comparing preoperative imaging with intraoperative identification of sentinel nodes. Patients were placed into two cohorts, based on the modality of preoperative imaging: (1) planar lymphoscintigraphy only (n = 63) and (2) single-photon emission computerized tomography combined with computerized tomography (SPECT-CT) only (n = 17). Sites of preoperative mapping and sites of intraoperative identification were recorded as parotid/preauricular, mastoid/postauricular, and/or cervical. RESULTS In patients that underwent planar lymphoscintigraphy preoperatively (n = 63), significantly more sentinel nodes were identified intraoperatively than were mapped preoperatively in both the parotid/preauricular (P = 0.0017) and mastoid/postauricular (P = 0.0047) regions. Thirty-two nodes were identified intraoperatively that were not mapped preoperatively in the planar lymphoscintigraphy group (n = 63), two of which were positive for micrometastatic disease. In contrast, there were no discrepancies between preoperative mapping and intraoperative identification of sentinel nodes in the SPECT-CT group (n = 17). CONCLUSIONS SPECT-CT is more accurate than planar lymphoscintigraphy for the preoperative identification of draining sentinel lymph nodes in auricular melanoma. If SPECT-CT is not available, planar lymphoscintigraphy can also be used safely, but careful intraoperative evaluation, even in basins not mapped by lymphoscintigraphy, must be performed to avoid missed sentinel nodes.
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Affiliation(s)
- Seth Noorbakhsh
- From the West Virginia University School of Medicine, Morgantown, W.V
| | | | - Renee M. Maina
- Yale School of Medicine Department of Surgery;, New Haven, Conn
| | - Raymond Baumann
- Department of Pharmacology, Database Management, Yale School of Medicine, New Haven, Conn
| | - Craig Moores
- Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Conn
| | - Sarah A. Weiss
- Section of Medical Oncology, Yale School of Medicine, New Haven, Conn
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn
| | - Stephan Ariyan
- Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Conn
| | - Kelly Olino
- Department of Surgery, Section of Surgical Oncology, Yale School of Medicine, New Haven, Conn
| | - James Clune
- Section of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Conn
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Moncrieff M, Pywell S, Snelling A, Gray M, Newman D, Beadsmoore C, Pawaroo D, Heaton M. Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes. Ann Surg Oncol 2021; 29:767-775. [PMID: 34704182 PMCID: PMC8724187 DOI: 10.1245/s10434-021-10911-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.
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Affiliation(s)
- Marc Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK. .,Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Sarah Pywell
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK
| | - Andrew Snelling
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK
| | - Matthew Gray
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - David Newman
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Clare Beadsmoore
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Davina Pawaroo
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Martin Heaton
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK
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Dell'Oglio P, de Vries HM, Mazzone E, KleinJan GH, Donswijk ML, van der Poel HG, Horenblas S, van Leeuwen FWB, Brouwer OR. Reply to Christian Daniel Fankhauser, Arie Parnham, Vijay Sangar's Letter to the Editor re: Paolo Dell'Oglio, Hielke M. de Vries, Elio Mazzone, et al. Hybrid Indocyanine Green- 99mTc-nanocolloid for Single-photon Emission Computed Tomography and Combined Radio- and Fluorescence-guided Sentinel Node Biopsy in Penile Cancer: Results of 740 Inguinal Basins Assessed at a Single Institution. Eur Urol 2020;78:865-72. Eur Urol 2021; 79:e74-e75. [PMID: 33436166 DOI: 10.1016/j.eururo.2020.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Hielke M de Vries
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gijs H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Quartuccio N, Garau LM, Arnone A, Pappalardo M, Rubello D, Arnone G, Manca G. Comparison of 99mTc-Labeled Colloid SPECT/CT and Planar Lymphoscintigraphy in Sentinel Lymph Node Detection in Patients with Melanoma: A Meta-Analysis. J Clin Med 2020; 9:jcm9061680. [PMID: 32498217 PMCID: PMC7356992 DOI: 10.3390/jcm9061680] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
We compared the detection rate (DR) for sentinel lymph nodes (SLN), the number of SLNs and the subjects with additional SLNs of single-photon emission computed tomography (SPECT/CT) and planar lymphoscintigraphy (PL) in patients with melanoma. Furthermore, we evaluated the impact of SPECT/CT on surgical plans. Articles containing head-to-head comparisons between SPECT/CT and PL were searched in Pubmed/MEDLINE and Scopus. The literature search was updated until December 31st, 2019. DR was calculated on a per patient-based analysis; the studies were pooled by their odds ratios (ORs) with a random effects model to assess the significance of difference (p < 0.05). The number of additional SLNs (calculated as the relative risk) and pooled proportion of patients with additional SLNs were investigated. The pooled ratio of surgical procedures influenced by the SPECT/CT findings was calculated. Seventeen studies with 1438 patients were eligible for the calculation of DR of SPECT/CT and PL. The average DR was 98.28% (95% confidence interval (95% CI): 97.94-99.19%) for the SPECT/CT and 95.53% (95% CI: 92.55-97.77%) for the PL; OR of 2.31 (95% CI: 1.66-4.18, p < 0.001) in favor of the SPECT/CT. There was a relative risk of a higher number of SLNs (1.13) for the SPECT/CT and 17.87% of patients with additional SLNs were detected by SPECT/CT. The average impact of SPECT/CT on surgery resulted in 37.43% of cases. This meta-analysis favored SPECT/CT over PL for the identification of SLNs in patients with melanoma due to a higher DR, reproducibility, number of SLNs depicted, proportion of patients with additional SLNs and the impact on the surgical plan. However, PL remains a good option due to the high values of the DR for SLNs.
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Affiliation(s)
- Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90128 Palermo, Italy; (N.Q.); (A.A.); (G.A.)
| | - Ludovico Maria Garau
- Regional Center of Nuclear Medicine, Hospital University of Pisa, 56126 Pisa, Italy; (L.M.G.); (G.M.)
| | - Annachiara Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90128 Palermo, Italy; (N.Q.); (A.A.); (G.A.)
| | - Marco Pappalardo
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, 90127 Palermo, Italy
- Correspondence: (M.P.); (D.R.)
| | - Domenico Rubello
- Nuclear Medicine Unit, Santa Maria della Misericordia Hospital, 35100 Rovigo, Italy
- Correspondence: (M.P.); (D.R.)
| | - Gaspare Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90128 Palermo, Italy; (N.Q.); (A.A.); (G.A.)
| | - Gianpiero Manca
- Regional Center of Nuclear Medicine, Hospital University of Pisa, 56126 Pisa, Italy; (L.M.G.); (G.M.)
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Abstract
Melanoma accounts for 7% of all cancers in adolescents ages 15-19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1-4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.
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Affiliation(s)
- Sue C Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN 220, Memphis, TN, 38105-3678, USA.
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
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11
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Clinical Value of Single-photon Emission Computed Tomography Combined With Computed Tomography for Sentinel Lymph Node Identification in Melanoma. Ann Plast Surg 2019; 82:S192-S194. [DOI: 10.1097/sap.0000000000001895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Stoffels I, Herrmann K, Rekowski J, Jansen P, Schadendorf D, Stang A, Klode J. Sentinel lymph node excision with or without preoperative hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) in melanoma: study protocol for a multicentric randomized controlled trial. Trials 2019; 20:99. [PMID: 30717811 PMCID: PMC6360709 DOI: 10.1186/s13063-019-3197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
Background Melanoma has become a growing interdisciplinary problem in public health worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Because melanoma metastasizes early into the regional lymph nodes, sentinel lymph node excision (SLNE) is included in the current American Joint Committee of Cancer guidelines. However SLNE of melanoma has a high false-negative rate of up to 44%. Methods The gold standard for detection and extirpation of the sentinel lymph node is preoperative lymphoscintigraphy. SPECT/CT provides complementary information: the advantages include accurate anatomical localization, identification of false positives, reduction in the number of false negatives, and alteration of the surgical approach. Therefore, sentinel lymph node-SPECT/CT provides valuable information before sentinel lymph node excision and advocates its use in melanoma. We present a multicenter, unblinded superiority randomized controlled trial to compare SPECT/CT-aided SLNE versus standard SLNE in melanoma patients. Discussion The primary efficacy endpoint is distant metastasis-free survival. Secondary endpoints comprise overall survival, disease-free survival, rate of local relapses within the follow-up period (false-negative rate of sentinel lymph node), number of positive sentinel lymph nodes (sensitivity, false-positive rate), complication rate, quality of life, quality-adjusted life years, inpatient days, and overall costs during hospital stays. Trial registration ClinicalTrials.gov, NCT03683550. Registered on 20 September 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3197-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingo Stoffels
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122, Essen, Germany
| | - Jan Rekowski
- Department of Nuclear Medicine, University of Essen-Duisburg, 45122, Essen, Germany
| | - Philipp Jansen
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Andreas Stang
- Department of Nuclear Medicine, University of Essen-Duisburg, 45122, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany. .,West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany. .,German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany.
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13
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Perissinotti A, Rietbergen DDD, Vidal-Sicart S, Riera AA, Olmos RA. Melanoma & nuclear medicine: new insights & advances. Melanoma Manag 2018; 5:MMT06. [PMID: 30190932 PMCID: PMC6122522 DOI: 10.2217/mmt-2017-0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/29/2018] [Indexed: 12/16/2022] Open
Abstract
The contribution of nuclear medicine to management of melanoma patients is increasing. In intermediate-thickness N0 melanomas, lymphoscintigraphy provides a roadmap for sentinel node biopsy. With the introduction of single-photon emission computed tomography images with integrated computed tomography (SPECT/CT), 3D anatomic environments for accurate surgical planning are now possible. Sentinel node identification in intricate anatomical areas (pelvic cavity, head/neck) has been improved using hybrid radioactive/fluorescent tracers, preoperative lymphoscintigraphy and SPECT/CT together with modern intraoperative portable imaging technologies for surgical navigation (free-hand SPECT, portable gamma cameras). Furthermore, PET/CT today provides 3D roadmaps to resect 18F-fluorodeoxyglucose-avid melanoma lesions. Simultaneously, in advanced-stage melanoma and recurrences, 18F-fluorodeoxyglucose-PET/CT is useful in clinical staging and treatment decision as well as in the evaluation of therapy response. In this article, we review new insights and recent nuclear medicine advances in the management of melanoma patients.
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Affiliation(s)
- Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Daphne DD Rietbergen
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Ana A Riera
- Department of Nuclear Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Carretera del Rosario 145, 08010 SC de Tenerife, Spain
| | - Renato A Valdés Olmos
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Nuclear Medicine, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Trinh BB, Chapman BC, Gleisner A, Kwak JJ, Morgan R, McCarter MD, Gajdos C, Kounalakis N. 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 2018; 25:1716-1722. [PMID: 29330718 DOI: 10.1245/s10434-017-6298-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 11/18/2022]
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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Affiliation(s)
- Becky B Trinh
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ana Gleisner
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer J Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rustain Morgan
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Martin D McCarter
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Csaba Gajdos
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Kounalakis
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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15
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Sibley R, Subramaniam RM. SPECT/CT: Looking Beyond Sentinel Lymph Node Identification for Improving Patient Outcomes. Ann Surg Oncol 2017; 25:1467-1468. [PMID: 29218428 DOI: 10.1245/s10434-017-6301-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Robert Sibley
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rathan M Subramaniam
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Harold Simmons Comprehensive Cancer Center, University of Texax Southwestern Medical Center, Dallas, TX, USA.
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Rubio-Rodríguez D, De Diego Blanco S, Pérez M, Rubio-Terrés C. Cost-Effectiveness of Drug Treatments for Advanced Melanoma: A Systematic Literature Review. PHARMACOECONOMICS 2017; 35:879-893. [PMID: 28551858 DOI: 10.1007/s40273-017-0517-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Until recently, advanced melanoma (unresectable and metastatic) has had a poor prognosis and has been treated with chemotherapy. The introduction of new treatments (BRAF and MEK inhibitors and immunotherapy) has improved overall survival and progression-free survival of some patients. OBJECTIVE The objective of this study was to review the published evidence on the cost-effectiveness of pharmacological treatments for advanced melanoma. METHODS A systematic literature search was conducted, without date or language restrictions, in PubMed, EMBASE, Scopus, the Cochrane Library, the UK National Institute for Health and Care Excellence databases and the Health Technology Assessment journal. Internet searches were also made to identify possible grey literature. Main study characteristics, methods and outcomes were extracted and critically assessed. The quality of health economic studies was assessed by the Quality Assessment of Economic Evaluation in Health Care checklist. RESULTS The search identified nine full-text pharmacoeconomic analyses of advanced melanoma treatments. According to the economic analyses published in the articles, the new treatments have been shown to be more effective (with more life-years and quality-adjusted life-years) than chemotherapy, although generally the cost per quality-adjusted life-year gained was above the commonly accepted threshold. Because of the variability of the available analyses comparing the new treatments, we cannot determine which treatment is the most cost-effective. CONCLUSIONS From the available data, it cannot be concluded that the new drugs (BRAF and MEK inhibitors and immunotherapy) are cost effective compared with chemotherapy or which is the most cost-effective new treatment.
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Affiliation(s)
| | | | - Maite Pérez
- Medical Department, AstraZeneca Farmacéutica Spain, Barcelona, Spain
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17
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Saad ZZ, Omorphos S, Michopoulou S, Gacinovic S, Malone P, Nigam R, Muneer A, Bomanji J. Investigating the role of SPECT/CT in dynamic sentinel lymph node biopsy for penile cancers. Eur J Nucl Med Mol Imaging 2017; 44:1176-1184. [PMID: 28175934 PMCID: PMC5434125 DOI: 10.1007/s00259-017-3636-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/17/2017] [Indexed: 01/20/2023]
Abstract
Purpose Currently, most centres use 2-D planar lymphoscintigraphy when performing dynamic sentinel lymph node biopsy in penile cancer patients with clinically impalpable inguinal nodes. This study aimed to investigate the role of SPECT/CT following 2-D planar lymphoscintigraphy (dynamic and static) in the detection and localization of sentinel lymph nodes in the groin. Methods A qualitative (visual) review was performed on planar followed by SPECT/CT lymphoscintigraphy in 115 consecutive patients (age 28–86 years) who underwent injection of 99mTc-nanocolloid followed by immediate acquisition of dynamic (20 min) and early static scans (5 min) initially and further delayed static (5 min) images at 120 min followed by SPECT/CT imaging. The lymph nodes detected in each groin on planar lymphoscintigraphy and SPECT/CT were compared. Results A total of 440 and 467 nodes were identified on planar scintigraphy and SPECT/CT, respectively. Overall, SPECT/CT confirmed the findings of planar imaging in 28/115 cases (24%). In the remaining 87 cases (76%), gross discrepancies were observed between planar and SPECT/CT images. SPECT/CT identified 17 instances of skin contamination (16 patients, 13%) and 36 instances of in-transit lymphatic tract activity (24 patients, 20%) that had been interpreted as tracer-avid lymph nodes on planar imaging. In addition, SPECT/CT identified 53 tracer-avid nodes in 48 patients (42%) that were not visualized on planar imaging and led to reclassification of the drainage basins (pelvic/inguinal) of 27 tracer-avid nodes. Conclusions The addition of SPECT/CT improved the rate of detection of true tracer-avid lymph nodes and delineated their precise (3-D) anatomic localization in drainage basins.
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Affiliation(s)
- Ziauddin Zia Saad
- Department of Nuclear Medicine, University College Hospitals London, London, UK.,Institute of Nuclear Medicine, 5th Floor,, UCLH NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Savvas Omorphos
- Department of Urology, University College Hospitals London, London, UK
| | - Sofia Michopoulou
- Department of Nuclear Medicine, University College Hospitals London, London, UK
| | - Svetislav Gacinovic
- Department of Nuclear Medicine, University College Hospitals London, London, UK
| | - Peter Malone
- Department of Urology, University College Hospitals London, London, UK
| | - Raj Nigam
- Department of Urology, University College Hospitals London, London, UK
| | - Asif Muneer
- Department of Urology, University College Hospitals London, London, UK
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College Hospitals London, London, UK. .,Institute of Nuclear Medicine, 5th Floor,, UCLH NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK.
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18
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Masud D, Bisarya K, Svensson W, Jallali N. Surgical evaluation of the use SPECT-CT in sentinel lymph node biopsies in primary cutaneous melanoma. J Plast Reconstr Aesthet Surg 2017; 70:40-41. [DOI: 10.1016/j.bjps.2016.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022]
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19
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Doepker MP, Yamamoto M, Applebaum MA, Patel NU, Jaime Montilla-Soler M, Sarnaik AA, Wayne Cruse C, Sondak VK, Zager JS. 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 2016; 24:355-361. [PMID: 27660259 DOI: 10.1245/s10434-016-5590-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Indexed: 01/31/2023]
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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Affiliation(s)
- Matthew P Doepker
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maki Yamamoto
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | | | - Nupur U Patel
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - C Wayne Cruse
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
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20
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Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach. Eur Arch Otorhinolaryngol 2016; 273:2621-8. [PMID: 27170361 DOI: 10.1007/s00405-016-4089-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/05/2016] [Indexed: 02/05/2023]
Abstract
Head and neck cancer (HNC) is predominantly a locoregional disease. Sentinel lymph node (SLN) biopsy offers a minimally invasive means of accurately staging the neck. Value in healthcare is determined by both outcomes and the costs associated with achieving them. Time-driven activity-based costing (TDABC) may offer more precise estimates of the true cost. Process maps were developed for nuclear medicine, operating room and pathology care phases. TDABC estimates the costs by combining information about the process with the unit cost of each resource used. Resource utilization is based on observation of care and staff interviews. Unit costs are calculated as a capacity cost rate, measured as a Euros/min (2014), for each resource consumed. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost for each phase of care. Three time equations with six different scenarios were modeled based on the type of camera, the number of SLN and the type of staining used. Total times for different SLN scenarios vary between 284 and 307 min, respectively, with a total cost between 2794 and 3541€. The unit costs vary between 788€/h for the intraoperative evaluation with a gamma-probe and 889€/h for a preoperative imaging with a SPECT/CT. The unit costs for the lymphadenectomy and the pathological examination are, respectively, 560 and 713€/h. A 10 % increase of time per individual activity generates only 1 % change in the total cost. TDABC evaluates the cost of SLN in HNC. The total costs across all phases which varied between 2761 and 3744€ per standard case.
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Stoffels I, Morscher S, Helfrich I, Hillen U, Leyh J, Burton NC, Sardella TCP, Claussen J, Poeppel TD, Bachmann HS, Roesch A, Griewank K, Schadendorf D, Gunzer M, Klode J. Metastatic status of sentinel lymph nodes in melanoma determined noninvasively with multispectral optoacoustic imaging. Sci Transl Med 2015; 7:317ra199. [PMID: 26659573 DOI: 10.1126/scitranslmed.aad1278] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ingo Stoffels
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Stefan Morscher
- iThera Medical GmbH, 81379 München, Germany. Institute for Biological and Medical Imaging, Technische Universität München, and Helmholtz Center Munich, 85764 München, Germany
| | - Iris Helfrich
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Uwe Hillen
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Julia Leyh
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | | | | | | | - Thorsten D Poeppel
- Department of Nuclear Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Hagen S Bachmann
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Klaus Griewank
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, Imaging Center Essen (IMCES), University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venerology, and Allergology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany. West German Cancer Center, University of Duisburg-Essen, 45122 Essen, Germany. German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
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EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging 2015. [PMID: 26205952 DOI: 10.1007/s00259-015-3135-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized melanoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with melanoma. METHODS These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, national nuclear medicine societies, the European Society of Surgical Oncology (ESSO) and the European Association for Research and Treatment of Cancer (EORTC) melanoma group. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). CONCLUSION The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of melanoma patients.
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Weiss M, Schwarz F, Wallmichrath J, Baumeister R, Frick A, Bartenstein P, Rominger A. Chylothorax and chylous ascites. Clinical utility of planar scintigraphy and tomographic imaging with SPECT/CT. Nuklearmedizin 2015; 54:231-40. [PMID: 26183818 DOI: 10.3413/nukmed-0723-15-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim was to analyze conventional planar scintigraphy and SPECT/CT in patients clinically suspicious for chylothorax or chylous ascites. Lymphoscintigraphy was performed for two reasons: first, to help diagnose chylothorax or -abdomen, by demonstrating diffuse uptake in fluid accumulations, and then secondly, to detect the site of leakage to test the prediction that additional use of SPECT/CT-technique improves upon the diagnostic value of planar lymphoscintigraphy in the baseline detection of thoraco-abdominal lymphatic disorders. PATIENTS, MATERIAL, METHODS From 7/2008-7/2014 a total of 24 consecutive patients (8 woman, 16 men; age, range 31-79 years) presenting with clinical symptoms suspicious for chylothorax and/or chylous ascites were examined by planar lymphoscintigraphy (n = 26) and additional tomographic SPECT/CT- (n = 22) or SPECT-technique (n = 2). RESULTS Chylothorax could be scintigraphically confirmed in n = 9, chylous ascites in n = 5 scintigraphies, and excluded in n = 10 patients. In all planar scintigraphy findings of pathological lymph drainage regions (n = 14), SPECT/CT delivered additional relevant information, notably the anatomic localization of the lymphatic leakage. For the baseline detection of thoraco-abdominal lymphatic transport disorders, lymphoscintigraphy showed sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%. CONCLUSIONS Our findings show that due to the particular advantages presented by tomographic separation of overlapping sources, SPECT/CT specifies better the anatomical sites, improving the localization of lymphatic leakage in aid of planning surgical re-interventions.
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Affiliation(s)
- M Weiss
- Mayo Weiss MD, Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistr.15, 81377 Muenchen, Germany, Tel. +49/(0)89/440 07 76 38, E-mail:
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Zoras O, Lasithiotakis K, Balch C. Uncertainties in the management of melanoma nodal metastasis. Eur J Surg Oncol 2015; 41:811-3. [PMID: 25980747 DOI: 10.1016/j.ejso.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022] Open
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Clinical Impact of Preoperative Sentinel Lymph Node Imaging With SPECT/CT in the Management of Interscapular Malignant Melanoma. Clin Nucl Med 2015; 40:762-3. [PMID: 26053719 DOI: 10.1097/rlu.0000000000000844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 31-year-old male patient with a biopsy-proven cutaneous malignant melanoma located in the interscapular area was referred to lymphoscintigraphy for preoperative sentinel lymph node mapping. Anterior and posterior planar images showed 3 hot spots suggesting left axillary sentinel nodes. Herein, we reported the contribution of preoperative SPECT/CT-guided sentinel lymph node excision on accurate staging, management, prognostic evaluation, and determination of the proper surgical positioning preoperatively.
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Bozzetto J, Dubreuil J, Rubello D, Giammarile F. Sentinel lymph node in melanoma: present aspects and future trends. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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SPECT/CT in imaging sentinel nodes. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sentinel node in melanoma and breast cancer. Current considerations. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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[Sentinel node in melanoma and breast cancer. Current considerations]. Rev Esp Med Nucl Imagen Mol 2014; 34:30-44. [PMID: 25455506 DOI: 10.1016/j.remn.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 11/21/2022]
Abstract
The main objectives of sentinel node (SN) biopsy is to avoid unnecessary lymphadenectomies and to identify the 20-25% of patients with occult regional metastatic involvement. This technique reduces the associated morbidity from lymphadenectomy and increases the occult lymphatic metastases identification rate by offering the pathologist the or those lymph nodes with the highest probability of containing metastatic cells. Pre-surgical lymphoscintigraphy is considered a "road map" to guide the surgeon towards the sentinel nodes and to localize unpredictable lymphatic drainage patterns. The SPECT/CT advantages include a better SN detection rate than planar images, the ability to detect SNs in difficult to interpret studies, better SN depiction, especially in sites closer to the injection site and better anatomic localization. These advantages may result in a change in the patient's clinical management both in melanoma and breast cancer. The correct SN evaluation by pathology implies a tumoral load stratification and further prognostic implication. The use of intraoperative imaging devices allows the surgeon a better surgical approach and precise SN localization. Several studies reports the added value of such devices for more sentinel nodes excision and a complete monitoring of the whole procedure. New techniques, by using fluorescent or hybrid tracers, are currently being developed.
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Valdés Olmos RA, Rietbergen DDD, Vidal-Sicart S. SPECT/CT and sentinel node lymphoscintigraphy. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0087-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Høilund-Carlsen PF, Gerke O, Vach W. Demonstrating the benefits of clinical nuclear imaging: is it time to add economic analysis? Eur J Nucl Med Mol Imaging 2014; 41:1720-2. [PMID: 24986737 DOI: 10.1007/s00259-014-2807-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark,
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