title: Hybrid SPECT/CT imaging of sentinel nodes in esophageal cancer: first results.
abstract: BACKGROUND
  Sentinel node (SN) biopsy in esophageal cancer has the potential of becoming an important tool for ruling out the presence of lymph node metastases in patients opted for less extensive surgery without neoadjuvant treatment.
  
  
  OBJECTIVE
  To investigate preoperative SN imaging in esophageal cancer using hybrid single photon emission computed tomography (SPECT)/CT.
  
  
  METHODS
  Eight patients with esophageal cancer scheduled for thoracoabdominal esophagectomy after neoadjuvant treatment, underwent endoscopic submucosal injection of (99m)Tc-nanocoll the day before surgery, followed by imaging with SPECT/CT for preoperative detection. Intraoperative detection of SNs was performed with a gamma probe.
  
  
  RESULTS
  SNs were identified by SPECT/CT in 7/8 cases (88%) and by gamma probe in all cases. The median number of identified lymph node stations with SN in the operating field was 1 (range 0-2) for SPECT/CT and 1 (range 1-3) for gamma probe. The median distance between the perceived location of the respective SN according to SPECT/CT and the location identified with the gamma probe was <5 mm (range <5-15 mm). In one patient who had a complete histologic response to neoadjuvant treatment in the primary tumor, there was one single metastasis that was not contained in one of the SNs.
  
  
  CONCLUSIONS
  Preoperative identification of sentinel nodes with hybrid SPECT/CT after endoscopic injection of radiocolloid is a technique with obvious potential for SN mapping in esophageal cancer.
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm jon.tsai@ki.se.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Tsai
authors.affiliation: Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm.
authors.forename: Fuat
authors.initials: F
authors.lastname: Celebioglu
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm.
authors.forename: Mats
authors.initials: M
authors.lastname: Lindblad
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
authors.forename: Esther
authors.initials: E
authors.lastname: Lörinc
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm.
authors.forename: Magnus
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Section of Imaging Physics, Huddinge Unit of Nuclear Medicine Physics, Karolinska University Hospital, Stockholm.
authors.forename: Annie
authors.initials: A
authors.lastname: Olsson
authors.affiliation: Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm.
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.affiliation: Division of Radiology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rimma
authors.initials: R
authors.lastname: Axelsson
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
keywords: SPECT/CT; Sentinel node; esophageal cancer