title: Sentinel lymph node biopsy in malignant eyelid tumor: hybrid single photon emission computed tomography/computed tomography and dual dye technique.
abstract: OBJECTIVE
  To study the utility of hybrid single photon emission computed tomography / computed tomography (SPECT/CT) scan and dual-dye technique in identification of the sentinel lymph node (SLN) in patients with an advanced malignant eyelid tumor.
  
  
  METHODS
  Nonrandomized prospective interventional study.
  
  
  METHODS
  setting: A tertiary eye care center. study population: Patients with an advanced malignant eyelid tumor without clinically involved regional lymph nodes. intervention: SLN biopsy was performed using dual-dye technique (a combination of radiotracer and vital blue dye) following localization by SPECT/CT. main outcome measures: Localization of SLN in the regional node basin by hybrid SPECT/CT scan; SLN identification rate using dual-dye technique; SLN positivity rate; false-negative rate; and complications, if any, of SLN biopsy.
  
  
  RESULTS
  Sixteen patients of biopsy-proven eyelid malignancy (7 squamous cell carcinomas [43.75%], 5 sebaceous cell carcinomas [31.25%], and 4 malignant melanomas [25%]) were included in the study. Preoperative localization of SLN was performed using SPECT/CT in 12 patients. SLN biopsy using dual-dye technique was performed in 16 patients. SPECT/CT accurately localized SLN in 11 out of 12 patients. The preauricular region was the most common site of SLN. SLN identification rates for dual-dye, radiotracer, and blue dye techniques were 100% (16/16 patients), 100% (16/16 patients), and 87.5% (14/16 patients), respectively. SLN showed metastasis in 2 patients (12.5%). On follow-up, 1 patient developed cervical lymph node metastasis, thus giving a false-negative rate of 7.14%. There were no complications associated with SLN biopsy.
  
  
  CONCLUSIONS
  Accurate preoperative localization of SLN in relation to adjacent anatomic structures using SPECT/CT aids in intraoperative identification of SLN. SLN biopsy should be considered in patients with eyelid tumors at significant risk for metastasis who have clinically negative nodal basins. Dual-dye technique is safe and feasible in advanced eyelid tumors. Blue dye technique can be used for SLN biopsy in settings where nuclear medicine facilities are not available, albeit with a lower SLN identification rate. Detection of metastasis in SLNs in ∼12% of cases emphasizes the utility of SLN biopsy in accurate staging and treatment of eyelid malignancies.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Seenu
authors.initials: S
authors.lastname: Vuthaluru
authors.forename: Neelam
authors.initials: N
authors.lastname: Pushker
authors.forename: Gautam
authors.initials: G
authors.lastname: Lokdarshi
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Bajaj
authors.forename: Seema
authors.initials: S
authors.lastname: Kashyap
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mathur
authors.forename: Bhavna
authors.initials: B
authors.lastname: Chawla
authors.forename: Saurbhi
authors.initials: S
authors.lastname: Khurana
authors.forename: Supriyo
authors.initials: S
authors.lastname: Ghose
mesh_terms: D018266:Adenocarcinoma, Sebaceous / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D004396:Coloring Agents; D005142:Eyelid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012626:Sebaceous Gland Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D013671:Technetium Tc 99m Sulfur Colloid; D014057:Tomography, X-Ray Computed
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid