Change in clinical management of sentinel lymph node location in early stage cervical cancer: the role of SPECT/CT |
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Authors: | Díaz-Feijoo Berta Pérez-Benavente María A Cabrera-Diaz Silvia Gil-Moreno Antonio Roca Isabel Franco-Camps Silvia Fernández Mónica Sabaté García-Jiménez Angel Xercavins Jordi Martínez-Palones José M |
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Institution: | a Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain;b Service of Nuclear Medicine, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain;c Department of Pathology, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain |
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Abstract: | ObjectiveThe aim of this study was to investigate the feasibility of the sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging in the early stage invasive cervical cancer in patients undergoing radical hysterectomy and pelvic lymphadenectomy.MethodsBetween March 2007 and June 2009, a prospective consecutive study was designed for SLN mapping. Twenty-two patients with cervical cancer FIGO stage IB1 (n = 20) or stage IIA1 (n = 2) underwent SLN identification with preoperative SPECT/CT and planar images (technetium-99 m colloid albumin injection around the tumor) and posterior intraoperative detection with both blue dye and a handheld or laparoscopic gamma probe. Complete pelvic lymphadenectomy was performed in all cases by open (n = 2) or laparoscopic (n = 20) surgery.ResultsIn the present series, a total of 35 SLN were detected with planar images and 40 SLN were identified and well located by SPECT/CT lymphoscintigraphy (median 2.0 nodes per patient). In 5/22 patients (22.7%) SPECT/CT procedure improves the number of localized SLN. Intraoperatively, 57 SLNs were identified, with a median of 3 SLNs per patient by gamma probe (a total of 53 hot nodes) and a median of 2 nodes per patient after blue dye injection (a total of 42 blue nodes). Microscopic nodal metastases (eight nodes, corresponding to four patients) were confirmed in 18.18% of cases; all these lymph nodes were previously detected as SLN. The remaining 450 nodes, including SLNs, following complete pelvic lymphadenectomy, were histologically negative.ConclusionsSentinel lymph node detection is improved by SPECT/CT imaging because of the increased number of SLN detected and the better tridimensional anatomic location, allowing easier intra-operative detection with gamma probe and showing, in this series, a 100% negative predictive value. |
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Keywords: | Sentinel lymph node Cervical cancer Lymphatic mapping Lymphoscintigraphy SPECT/CT |
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