title: Preoperative sentinel node mapping with (99m)Tc-nanocolloid SPECT-CT significantly reduces the intraoperative sentinel node retrieval time in robot assisted laparoscopic cervical cancer surgery.
abstract: OBJECTIVE
  To compare preoperative sentinel node (SN) mapping with planar lymphoscintigraphy (LSG) to single photon emission computed tomography with computed tomography (SPECT-CT) for differences in intraoperative SN retrieval time in surgically treated cervical cancer patients.
  
  
  METHODS
  In cervical cancer patients planned for radical surgery, one day preoperatively, 220-290 MBq technetium-99m-nanocolloid was injected intracervically in four quadrants. Subsequent SN mapping was performed by either LSG (09.2009-03.2011) or SPECT-CT (03.2011-10.2012). The SN resection, by four armed robot assisted laparoscopy, was based on blue dye and technetium-99m and followed by pelvic lymph node dissection. Timing of perioperative care, including SN procedure times, was prospectively registered.
  
  
  RESULTS
  Out of the 62 subjects included, 33 (53.2%) underwent LSG and 29 (46.8%) SPECT-CT. No significant differences in baseline characteristics were observed. Bi- and unilateral SN visualization rates were 75.8% and 15.2% for LSG versus 86.2% and 6.9% for SPECT-CT (p=0.299 and p=0.305, respectively). Intraoperative bi/unilateral SN detection occurred in 84.8% and 9.1% of LSG subjects versus 89.7% and 3.4% for SPECT-CT (p=0.573 and p=0.616). Correlation in SN location between mapping and surgery was low for LSG (Spearman ρ=0.098; p=0.449) but high for SPECT-CT (ρ=0.798; p<0.001). Bilateral intraoperative SN retrieval times for LSG and SPECT-CT were 75.4±33.5 and 50.1±15.6 min, resulting in an average difference of 25.4 min (p=0.003).
  
  
  CONCLUSIONS
  SPECT-CT significantly reduces intraoperative SN retrieval with a clinically relevant time compared to LSG. The trend towards better bilateral visualization rates and significantly higher anatomical concordance may partly explain the observed difference in SN retrieval time.
authors: Department of Gynaecological Oncology, Division of Woman and Baby, University Medical Center Utrecht, The Netherlands. j.hoogendam@umcutrecht.nl
authors: Jacob P
authors: JP
authors: Hoogendam
authors: Monique G G
authors: MG
authors: Hobbelink
authors: Wouter B
authors: WB
authors: Veldhuis
authors: René H M
authors: RH
authors: Verheijen
authors: Paul J
authors: PJ
authors: van Diest
authors: Ronald P
authors: RP
authors: Zweemer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D008197:Lymph Node Excision; D061305:Lymphoscintigraphy / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging; D061646:Operative Time; D010388:Pelvis; D049268:Positron-Emission Tomography; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012371:Robotics; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013667:Technetium; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D019275:Radiopharmaceuticals; D013667:Technetium