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. 2009 Jun;16(6):1537-42.
doi: 10.1245/s10434-009-0339-2. Epub 2009 Jan 29.

The yield of SPECT/CT for anatomical lymphatic mapping in patients with melanoma

Iris M C van der Ploeg  1 , Renato A Valdés Olmos, Bin B R Kroon, Michael W J M Wouters, Michiel W M van den Brekel, Wouter V Vogel, Cornelis A Hoefnagel, Omgo E Nieweg
Affiliations

The yield of SPECT/CT for anatomical lymphatic mapping in patients with melanoma

Iris M C van der Ploeg et al. Ann Surg Oncol. 2009 Jun.

Abstract

Background: The hybrid single-photon emission computed tomography camera with integrated CT (SPECT/CT) fuses tomographic lymphoscintigrams with anatomical CT data. SPECT/CT shows the exact anatomical location of a sentinel node and may detect additional drainage. The purpose of this study was to explore its potential in patients with melanoma.

Methods: We studied 85 patients with melanoma with conventional lymphoscintigrams that were difficult to interpret (51 patients), that showed an unusual drainage pattern (33 patients), or with nonvisualization (1 patient). Forty-one patients had melanoma on an extremity, 31 on the trunk, and 14 in the head and neck region. SPECT/CT was performed following late conventional imaging without reinjection of the radiopharmaceutical.

Results: Conventional imaging suggested 214 sentinel nodes in 84 of the 85 patients (99%). SPECT/CT showed these same nodes and 12 extra sentinel nodes in seven patients (8%). Ten of these additional nodes were harvested, of which three nodes of two patients harbored metastases. There was a clear advantage of SPECT/CT in 30 patients (35%), resulting in a different incision in 17 patients, an incision at another site in 8, and an extra incision in 5 patients. The value was questionable in 19 patients (22%) in whom sentinel nodes were more clearly visualized by SPECT/CT, although the incision remained unchanged. There was no additional value of SPECT/CT in 36 patients (42%).

Conclusions: SPECT/CT detects additional drainage and shows the exact anatomical location of sentinel nodes in patients with inconclusive conventional lymphoscintigrams. SPECT/CT facilitates surgical exploration in difficult cases and may improve staging.

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