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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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Stathaki MI, Kapsoritakis N, Michelakis D, Anagnostopoulou E, Bourogianni O, Tsaroucha A, Papadaki E, de Bree E, Koukouraki S. The impact of sentinel lymph node mapping with hybrid single photon emission computed tomography/computed tomography in patients with melanoma. Comparison to planar radioisotopic lymphoscintigraphy. Melanoma Res 2023; 33:239-246. [PMID: 37053074 DOI: 10.1097/cmr.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
We studied the diagnostic value of 16 slices of single photon emission computed tomography (SPECT)/computed tomography (CT) in the anatomical localization, image interpretation and extra-sentinel lymph nodes (SLNs) detection compared to dynamic and static planar radioisotopic lymphoscintigraphy (PLS) in patients with melanoma. Eighty-two patients with melanoma underwent dynamic PLS, static PLS and SPECT/CT. Data were obtained using a dual head SPECT/CT 16 slices γ-camera. We evaluated the number and localization of SLNs detected with each imaging method. SPECT/CT demonstrated 48 additional SLNs in comparison with PLS in 29 patients. In five truncal and seven head-neck lesions, dynamic and static PLS failed to detect the SLNs found on SPECT/CT (false negative). In one case of truncal and one case of lower limb melanoma, the foci of increased activity interpreted on PLS as possible SLNs were confirmed to be non-nodal sites of uptake on SPECT/CT (false positive). PLS underestimated the number of SLNs detected, whereas SPECT/CT revealed higher agreement compared to the respective number from histological reports. SPECT/CT showed a better prediction of the number of SLNs and higher diagnostic parameters in comparison to planar imaging. SPECT/CT is an important complementary diagnostic modality to PLS, that improves detection, preoperative evaluation, anatomical landmarks of SLNs and surgical management of patients with melanoma.
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Affiliation(s)
- Maria I Stathaki
- Department of Nuclear Medicine, University Hospital of Heraklion
| | | | | | | | - Olga Bourogianni
- Department of Nuclear Medicine, University Hospital of Heraklion
| | | | | | - Eelco de Bree
- Department of Surgical Oncology, University Hospital of Heraklion, Crete, Greece
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Zhang S, Zhu S, Hua S, Zou X, Luo Y. The Importance of SPECT/CT in Preoperative Localization of Sentinel Lymph Nodes in 2 Patients With Acral Melanoma in the Foot. Clin Nucl Med 2022; 47:e32-e33. [PMID: 34028420 DOI: 10.1097/rlu.0000000000003700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 68-year-old woman with melanoma in the left heel underwent sentinel node lymphoscintigraphy and radioguided biopsy. The sentinel node lymphoscintigraphy with SPECT/CT detected 3 foci of increased activity in the popliteal fossa and inguinal region. When coregistered to CT, the sentinel node was localized in the inguinal region, and the popliteal foci were considered tracer retention in lymphatic vessel. In another patient with melanoma in the foot, sentinel node lymphoscintigraphy detected 3 foci of increased activity in the popliteal fossa and inguinal region, which were all identified to be nodal uptake in SPECT/CT. The sentinel node was finally localized in popliteal fossa in this patient.
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Affiliation(s)
| | | | | | - Xiongfei Zou
- Orthopedics, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, People's Republic of China
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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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Beniey M, Tran A, Boulva K. Mapping sentinel lymph nodes in cutaneous melanoma: a vast array of perioperative imaging modalities. Melanoma Res 2021; 31:108-118. [PMID: 33156132 DOI: 10.1097/cmr.0000000000000704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sentinel lymph node biopsy (SLNB) is a decisive step in the staging process of melanoma, critically impacting patients' oncological outcome and driving the decision-making process. SLNB limits the extent of the dissection in cases where no metastases are found. Conversely, when metastases are detected, SLNB has the potential to improve regional control of the disease when complete lymphadenectomy or early administration of adjuvant treatment are indicated. Thus, accurately identifying sentinel lymph nodes represents an important prognostic factor. Several strategies have been studied, including novel procedures that are not commonly used in the clinical setting. This review highlights the different tracers, preoperative and intraoperative imaging modalities studied to perform SLNB in cutaneous melanoma. The development of innovative modalities has been fueled by a need to optimize current approaches, offering new alternatives that can overcome some of the limitations of the standard method.
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Affiliation(s)
| | - Alphonse Tran
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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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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Quartuccio N, Siracusa M, Pappalardo M, Arnone A, Arnone G. Sentinel Node Identification in Melanoma: Current Clinical Impact, New Emerging SPECT Radiotracers and Technological Advancements. An Update of the Last Decade. Curr Radiopharm 2020; 13:32-41. [PMID: 31749441 PMCID: PMC7509753 DOI: 10.2174/1874471012666191015100837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/20/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Melanoma is the most lethal skin cancer with a mortality rate of 262 cases per 100.000 cases. The sentinel lymph node (SLN) is the first lymph node draining the tumor. SLN biopsy is a widely accepted procedure in the clinical setting since it provides important prognostic information, which helps patient management, and avoids the side effects of complete lymph node dissection. The rationale of identifying and removing the SLN relies on the low probability of subsequent metastatic nodes in case of a negative histological exam performed in the SLN. DISCUSSION Recently, new analytical approaches, based on the evaluation of scintigraphic images are also exploring the possibility to predict the metastatic involvement of the SLN. 99mTc-labeled colloids are still the most commonly used radiotracers but new promising radiotracers, such as 99mTc- Tilmanocept, are now on the market. In the last decades, single photon emission computed tomography- computerized tomography (SPECT/CT) has gained wider diffusion in clinical departments and there is large evidence about its superior diagnostic accuracy over planar lymphoscintigraphy (PL) in the detection of SLN in patients with melanoma. Scientists are also investigating new hybrid techniques combining functional and anatomical images for the depiction of SLN but further evidence about their value is needed. CONCLUSION This review examined the predictive and prognostic factors of lymphoscintigraphy for metastatic involvement of SLN, the currently available and emerging radiotracers and the evidence of the additional value of SPECT/CT over PL for the identification of SLN in patients with melanoma. Finally, the review discussed the most recent technical advances in the field.
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Affiliation(s)
- Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
- Address correspondence to this author at the Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy; Tel: +39091 666 2319; E-mail:
| | - Massimiliano Siracusa
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Marco Pappalardo
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Annachiara Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Gaspare Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
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Thomas CM, Khan MN, Mohan R, Hendler A, Hosni A, Chepeha DB, Goldstein DP, Cooper RM, Almeida JR. Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique. Head Neck 2019; 42:385-393. [DOI: 10.1002/hed.26011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/25/2019] [Accepted: 10/30/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Carissa M. Thomas
- Department of Otolaryngology – Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health Network, University of Toronto Toronto Ontario Canada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario Canada
| | - Mohemmed N. Khan
- Department of Otolaryngology – Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health Network, University of Toronto Toronto Ontario Canada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario Canada
| | - Ravi Mohan
- Department of AnesthesiaUniversity of Toronto Toronto Ontario Canada
| | - Aaron Hendler
- Department of AnesthesiaUniversity of Toronto Toronto Ontario Canada
| | - Ali Hosni
- Department of Radiation OncologyUniversity of Toronto Toronto Ontario Canada
| | - Douglas B. Chepeha
- Department of Otolaryngology – Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health Network, University of Toronto Toronto Ontario Canada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology – Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health Network, University of Toronto Toronto Ontario Canada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario Canada
| | - Richard M Cooper
- Department of AnesthesiaUniversity of Toronto Toronto Ontario Canada
| | - John R. Almeida
- Department of Otolaryngology – Head and Neck Surgery, Princess Margaret Cancer CentreUniversity Health Network, University of Toronto Toronto Ontario Canada
- Department of Surgical Oncology, Princess Margaret Cancer CentreUniversity Health Network Toronto Ontario Canada
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