title: 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.
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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy. alessandro.buda@fastwebnet.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Buda
authors.forename: Federica
authors.initials: F
authors.lastname: Elisei
authors.forename: Maurizio
authors.initials: M
authors.lastname: Arosio
authors.forename: Carlotta
authors.initials: C
authors.lastname: Dolci
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Perego
authors.forename: Daniela
authors.initials: D
authors.lastname: Giuliani
authors.forename: Dario
authors.initials: D
authors.lastname: Recalcati
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cattoretti
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012196:Review Literature as Topic; D021701:Sentinel Lymph Node Biopsy; D013671:Technetium Tc 99m Sulfur Colloid; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery
chemical_list: D013671:Technetium Tc 99m Sulfur Colloid