Multi-slice SPECT/CT vs. lymphoscintigraphy and intraoperative gamma ray probe for sentinel node mapping in HNSCC

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Early-stage head and neck squamous cell carcinoma (HNSCC) requires accurate staging for effective treatment.
• Sentinel node (SN) biopsy is crucial for staging, but precise preoperative mapping remains a challenge.

Purpose of the Study:

• To evaluate the diagnostic accuracy of multi-slice single-photon emission computed tomography/computed tomography (SPECT/CT) for preoperative SN mapping in early-stage HNSCC.
• To compare the efficacy of SPECT/CT with planar lymphoscintigraphy (LS) in identifying SNs.

Main Methods:

• Retrospective case-control study of HNSCC patients treated between November 2011 and December 2015.
• Diagnostic accuracy of multi-slice SPECT/CT assessed against the gold standard intraoperative gamma ray detection probe.
• Statistical analysis included McNemar's test and ROC curve analysis; hot spot yield compared between SPECT/CT and LS.

Main Results:

• SPECT/CT demonstrated high diagnostic accuracy (90.8%) with a negative predictive value of 96.3% compared to the intraoperative probe.
• SPECT/CT identified more hot spots than planar lymphoscintigraphy and provided superior anatomical detail and additional findings.
• Sentinel lymph node biopsy achieved an excellent excision rate (97%), confirming its reliability and safety.

Conclusions:

• Multi-slice SPECT/CT is a highly accurate imaging modality for preoperative sentinel node mapping in early-stage HNSCC.
• SPECT/CT offers significant advantages over planar lymphoscintigraphy, including improved anatomical localization and detection of additional relevant findings.
• The integration of SPECT/CT enhances the precision and reliability of sentinel node biopsy in HNSCC management.