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Integration of Hybrid Single-Photon Emission Computed Tomography/Computed Tomography in the Preoperative Assessment of Sentinel Node in Patients With Cervical and Endometrial Cancer: Our Experience and Literature Review
  1. Alessandro Buda, MD*,
  2. Federica Elisei, MD,
  3. Maurizio Arosio, MD,
  4. Carlotta Dolci, MD,
  5. Mauro Signorelli, MD*,
  6. Patrizia Perego, MD,
  7. Daniela Giuliani, MD*,
  8. Dario Recalcati, MD*,
  9. Giorgio Cattoretti, Professor,
  10. Rodolfo Milani, Professor* and
  11. Cristina Messa, Professor,§
  1. *Departments of Obstetrics and Gynecology,
  2. Departments of Nuclear Medicine, Bioimaging Molecular Centre, and
  3. Departments of Pathology, University of Milano-Bicocca, San Gerardo Hospital, Monza; and
  4. §Departments of Fondazione Tecnomed, University of Milano-Bicocca, IBFM-CNR, Monza, Italy.
  1. Address correspondence and reprint requests to Alessandro Buda, MD, Department of Obstetrics and Gynecology, Via Pergolesi, 33, 20900 Monza (MB), Italy. E-mail: alessandro.buda@fastwebnet.it.

Abstract

Objective The purpose of this study was to assess whether there is an additional value of single-photon emission computed tomography/computed tomography (SPECT/CT) over lymphoscintigraphy (LSG) alone for sentinel node (SN) mapping in endometrial and cervical cancer.

Methods Ten women with clinically cervical stage IA2 to stage IB1 and 25 women with stage I endometrial cancer underwent preoperative LSG for SN mapping. Technetium Tc 99m albumin nanocolloid was injected submucosally at 4 points of the cervix. Patients underwent SPECT/CT emission-transmission study at least 3 hours after standard planar images. Methylene blue was injected into the cervix just before surgery under general anesthesia. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and radical regional nodal dissection. Hot and/or blue nodes were labeled as SNs.

Results Conventional planar imaging detection rate was 50%, whereas the detection rate of at least one SN with SPECT/CT was 91% (32/35); bilateral detection was achieved in 7 (39%) of 18 women in planar and in 17 (53%) of 32 women in SPECT/CT imaging, respectively. Bilateral detection was achieved in 57% of women (20/35). Sentinel nodes were located in external and internal iliac nodes (66%), obturator nodes (5%), internal iliac nodes (11%), common iliac nodes (9%), and presacral nodes (9%). Lymph node involvement was identified in 5 patients (14%). Sentinel node correctly predicted lymph node involvement in all node-positive patients. Sentinel node sensitivity and negative predictive value of SPECT/CT were 100%.

Conclusions Single photon emission computed tomography/computed tomography seems to improve intraoperative identification of SNs and provides additional useful information about the anatomic location of SNs compared to planar LSG in cervical and endometrial cancer.

  • Sentinel node detection
  • Preoperative SPECT/CT
  • Uterine cancer

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Footnotes

  • The authors declare that there are no conflicts of interest.

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