Value and Advantages of Preoperative Sentinel Lymph Node Imaging With SPECT/CT in Cervical Cancer

2014 ◽  
Vol 24 (2) ◽  
pp. 295-302 ◽  
Author(s):  
Ruediger Klapdor ◽  
Johanna Mücke ◽  
Michael Schneider ◽  
Florian Länger ◽  
Klaus-Friedrich Gratz ◽  
...  

ObjectivePrecise detection of sentinel lymph nodes (SLNs) seems to be a crucial factor for optimized treatment of cervical cancer. We assess the use of single photon emission computed tomography combined with computed tomography (SPECT/CT) as an alternative to lymphoscintigraphy (LSG) for preoperative identification of SLN.MethodsThis study was performed in a prospective, unicentric setting. Patients with cervical carcinoma were scheduled for surgery and additional SLN labeling by peritumoral injection of 10 MBq technetium-99m-nanocolloid and patent blue. Thirty minutes after injection, LSG and SPECT/CT were carried out. We evaluated the number of SLNs detected intraoperatively in LSG and SPECT/CT and the histologic findings of SLN and non-SLN. Subsequently, we determined the impact of these results on the therapeutic approach.ResultsThis represents the largest study about SPECT/CT for SLN detection in cervical cancer so far. Between August 2008 and March 2013, 59 cervical cancer patients underwent intraoperative SLN detection. In addition, 51 of these patients underwent preoperative LSG and SPECT/CT. Imaging with SPECT/CT detected singular SLN at significantly higher rate (47/51, 92.2%) than that with planar LSG (43/51, 84.3%, P = 0.044). Furthermore, SPECT/CT performed better than LSG regarding the total number of detected SLN (SPECT/CT median, 3 [0–18]; LSG median, 2 [0–15]) and detection rates per pelvic side (SPECT/CT 76.9%, LSG 69.2%, P < 0.01). Whenever SLN detection succeeded, histologic evaluation of SLN correctly predicted the lymph node status per patient’s side. Using this type of diagnostic approach for lymph node staging, we reached sensitivity of 100% and negative predictive value of 100% at a rate of false-negative results of 0% even in tumors larger than 4 cm.ConclusionsSingle photon emission computed tomography combined with computed tomography imaging leads to improved rates of SLN detection and better anatomic correlation compared with planar LSG. Thus, intraoperative detection of SLN can be improved by preoperative SPECT/CT imaging. This enhances the clinical value of SLN technique and improves the oncologic safety of SLN concept.

2018 ◽  
Vol 28 (7) ◽  
pp. 1369-1376 ◽  
Author(s):  
Linqi Zhang ◽  
Qiao He ◽  
Ming Jiang ◽  
Bing Zhang ◽  
Xi Zhong ◽  
...  

BackgroundInsufficiency fractures (IFs) are a type of stress fracture caused by the effects of normal or physiological stresses on abnormally weakened bone. Frequently, these fractures are occult, and a portion of these fractures is misdiagnosed as bone metastases on a whole-body bone scan (WBS). The aim of this study was to evaluate a potential benefit of single-photon emission computed tomography/computed tomography (SPECT/CT) with metabolic and morphological imaging to diagnose IF in patients with cervical cancer after radiotherapy.MethodsThis article presents a retrospective review of 35 patients with cervical cancer after radiotherapy in patients (females; mean age, 55.94 ± 8.75 years; range, 36–73 years) who were referred to have WBS to determine whether there was any bone metastasis. The criterion standard was based on radiological investigations, clinical information, and follow-up at a minimum of 12 months.ResultsInsufficiency fractures were most frequently observed in the sacrum, accounting for 52.5% (21/40) of lesions. Fracture lines or sclerotic lines were noted in the IF lesion in 19 of 40 lesions on CT, and osteosclerosis was seen in 31 of 40 lesions. On WBS analysis, the sensitivity for detected lesions was 87.5% (42/48) for WBS. Nineteen lesions were interpreted as benign, 6 lesions were malignant, and 21 (43.8%) lesions were equivocal. Based on the criterion standard, WBS had an accuracy of only 47.9% (23/48). On SPECT/CT analysis, all of the lesions were observed on SPECT/CT; only 3 (6.25%) of 48 lesions were equivocal, and the accuracy was 89.6% (43/48).ConclusionsSingle-photon emission computed tomography/computed tomography should be included in the differential diagnoses when lesions show elevated technetium Tc 99m–labeled methylene diphosphonate uptake on WBS. Compared with a WBS alone, a more accurate diagnosis of IF can be obtained using SPECT/CT, which resulted not only in fewer equivocal lesions but also in a higher diagnostic accuracy.


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