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Identifier

000448603

Title

Hybrid imaging Spect/CT in sentinel lymph node detection in patients with melanoma

Alternative Title

Υβριδική απεικόνιση Spect/CT στην ανίχνευση του λεμφαδένα φρουρού σε ασθενείς με μελάνωμα

Author

Καψωριτάκης, Νικόλαος

Thesis advisor

Κουκουράκη, Σοφία

Reviewer

Eelco De Bree
Αγγελάκη, Σοφία

Abstract

Introduction: Sentinel lymph node (SLN) biopsy and its preoperative localization consist of an important advancement in the surgical approach of melanoma patients. Purpose: The purpose of this study is the evaluation of the diagnostic value and the clinical impact of hybrid tomographic imaging (SPECT/CT) technique with 16 slices in detecting and localizing SLN(s) in patients with melanoma vs planar dynamic and static radioisotopic lymphoscintigraphy (PLSs, PLSd). Materials and Methods: From January 2019 to November 2021 82 patients with melanoma located in the head-neck area (n=20), the trunk (32), on the upper extremity (14) and the lower extremity (16) were included in our study. All of them initially underwent planar PLSs and PLSd after intradermally injection of radiolabeled nanocolloid albumin particles with99mTc. Subsequently, hybrid imaging, single-photon emission tomography combined with computerized tomography (SPECT/CT) was performed. Qualitative analysis was performed in order to evaluate the number and location of the sentinel lymph node(s) in both imaging techniques and to assess the additional clinical value of SPECT/CT vs planar lymphoscintigraphy (PLS). Statistical analysis was performed for both imaging methods having as gold standard the histopathological report. Results: According to the histology report, sentinel nodes were harvested84 anatomical regions, including the axilla in 52 patients (62%) and the inguinal and the head and neck region each in 16 patients (19.0%). Planar imaging resulted in localization of lymph node in 68anatomical areas: 55 (80.9%), axillary, 9 (13.2%) inguinal and 4 (5.9%) in the head and neck area. Summing the results of SPECT-CT imaging, the 86 lymph node localizations per anatomical region were: 53 (61.9%) axillary, 17 (19.8%) inguinal and 16 (18.6%) in the head and neck area. Agreement in localization was 5 measured using kappa statistic between histology report and both imaging techniques. SPECT-CT showed higher agreement with histological reports (kappa=0.525, p<0.001). Agreement between both imaging techniques was less than moderate (kappa=0.394, p<0.001). The location of lymph nodes measured using histological examination and those observed at SPECT/CT imaging showed a higher correlation (r=0.743,rs=0.770) compared to PLS(r=0.331,rs=0.223). PLS underestimates the number of lymph nodes in comparison to histology examination. Additionally, the number of lymph nodes estimated using SPECT-CT were closer to respective numbers from the histology report. Conclusion: Hybrid SPECT/ CT is an important diagnostic method with high impact in daily clinical practice offering a contribution in the more precise preoperative evaluation of the number and localization of sentinel lymph nodes. The clinical impact of SPECT/CT is to help to a better therapeutic decision making by reducing the false negative and false positive results, especially in difficult cases with unpredictable lymphatic drainage like in pts with head and neck and trunk melanoma. Moreover, SPECT/CT is very useful in more precise staging, treatment approach, and prognosis of the patients.

Language

English

Subject

Radioisotopic lemphangiography

SPECT/CT

Λεμφαδένας φρουρός

Ραδιοϊσοτοπική Λεμφαγγειογραφία

Issue date

2022-07-29

Collection

School/Department--School of Medicine--Department of Medicine--Post-graduate theses

Type of Work--Post-graduate theses