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[Utility of single photon emission computed tomography-computed tomography in selective sentinel lymph node biopsy in
R Martínez Castillo1, R Fernández López1, I Acevedo Bañez1
1Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España.
Objective:
To assess the contribution of SPECT-CT lymphoscintigraphy in selective sentinel lymph node biopsy (SLNB) in patients with newly diagnosed malignant melanoma.
Material And Methods:
A prospective study was made between July 2009 and October 2010. It included 63 patients diagnosed with melanoma (32 men and 31 women) with mean age of 55 years (range: 25-88) and inclusion criteria for SLNB. The melanomas were located as follows: 28 in trunk, 5 in head and neck, 16 in upper limbs and 17 in lower limbs. Three patients had two melanomas. Preoperative lymphoscintigraphy was performed after pericicatricial/perilesional injection of 74MBq of (99m)Tc-labeled nanocolloid human serum albumin, obtaining early planar images, late whole body study and sectorial images and SPECT-CT in the area of interest. Planar scintigraphy findings were compared with SPECT-CT.
Results:
The sentinel node (SN) was localized by planar imaging in 62/63 (98%) of patients. SPECT-CT study located the SN in all the patients with a detection rate of 100%. The number of SNs detected with SPECT-CT was higher than with the planar study in 27 patients. The SPECT-CT provided additional information (change in location and/or in its accuracy in the localization of location uncertain SN) in 14/63 (22.2%) patients, involving changes in the surgical approach and lymph node staging.
Conclusion:
SPECT-CT detects a higher number of SN than planar lymphoscintigraphy in patients with melanoma. Its contribution is more relevant in the melanomas located on the trunk, head and neck. SPECT-CT modified the SN location by 22% compared to planar scan findings, facilitating a correct surgical approach.
