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Abstract

We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors.

METHODS:

From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day.

RESULTS:

Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer.

CONCLUSION:

SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI. 

Author information

​Jimenez-Heffernan A1, Ellmann A2, Sado H3, Huić D4, Bal C5, Parameswaran R6, Giammarile F7, Pruzzo R8, Kostadinova I9, Vorster M10, Almeida P11, Santiago J12, Gambhir S13, Sergieva S14, Calderon A15, Young GO16, Valdes-Olmos R17, Zaknun J18, Magboo VP19, Pascual TN20.​

1Hospital Juan Ramon Jimenez, Huelva, Spain.

2Stellenbosch University, Tygerberg Hospital, Stellenbosch, South Africa.

3Instituto Do Cancer de Sao Paulo, Sao Paulo, Brazil.

4University Hospital Centre Zagreb, Zagreb, Croatia.

5All India Institute of Medical Sciences, New Delhi, India.

6Manipal Hospital, Bangalore, India.

7Hospices Civils, University of Lyon 1, Lyon, France.

8Fundacion Arturo Lopez Perez, Santiago, Chile.

9University Hospital Alexandrovska, Sofia, Bulgaria.

10Pretoria Academic Hospital, Pretoria, South Africa.

11Real Hospital Português, Recife, Brazil.

12St. Lukes Medical Center, Quezon City, Philippines.

13Sanjay Gandhi Institute of Medical Sciences, Lucknow, India.

14Sofia Cancer Center, Sofia, Bulgaria.

15Instituto Nacional de Cancerlologia, Bogota, Colombia.

16Universidade de Sao Paulo, Sao Paulo, Brazil.

17The Netherlands Cancer Institute, Amsterdam, The Netherlands.

18IAEA, Vienna, Austria; and.

19University of the Philippines Manila, Manila, Philippines.

20IAEA, Vienna, Austria; and T.Pascual@iaea.org.