title: Is there a place for sentinel technique in treatment of vaginal cancer?: feasibility, clinical experience, and results.
abstract: OBJECTIVE
  To evaluate the clinical feasibility of sentinel lymph node (SLN) technique and the role of single-photon emission computed tomography with CT (SPECT/CT) compared to lymphoscintigraphy for detection of SLN in vaginal cancer.
  
  
  METHODS
  The study was performed in a prospective, unicentric setting. Patients with vaginal carcinoma were scheduled for surgery and SLN labeling by peritumoral injection of 10-MBq technetium Tc 99m nanocolloid and patent blue. After 30 minutes, lymphoscintigraphy and SPECT/CT were carried out. We evaluated the number of SLNs in lymphoscintigraphy, SPECT/CT, and intraoperative histology of SLN and non-SLN as well as the impact of these results to therapeutic approach.
  
  
  RESULTS
  Between January 2009 and December 2012, the SLN technique was used for 7 of 11 patients treated due to vaginal cancer. Detection rate was 100% (7/7). Lymphoscintigraphy and SPECT/CT showed at least one SLN in each patient. Lymphoscintigraphy detected 2.6 SLNs (range, 2-4 SLNs) per patient compared to 4.3 SLNs (range, 2-8 SLNs) in SPECT/CT (P = 0.053). Sentinel lymph nodes were detected in all patients during surgery with a mean number of 4.3 (range, 1-5). Pelvic SLNs were detected in all 6 patients with infiltration of middle or proximal vaginal third (100%). If the distal vaginal third was additional (3/7 patients) or exclusively (1/7 patients) infiltrated, the inguinal SLN detection rate was 33% and 100%, respectively. All patients with nodal metastases had at least one SLN positive for tumor. There were no false negatives. In 2 (29%) of 7 patients, treatment approach was modified owing to affected SLN.
  
  
  CONCLUSIONS
  The SLN technique was favorably used in vaginal cancer in this series. It assists in identifying an inguinal and/or pelvic lymphatic drainage. When performed accurately (technetium Tc 99m nanocolloid, lymphoscintigraphy and/or SPECT/CT, blue dye), this technique predicts regional nodal status. This allows tumor stage-adjusted therapy. Single photon emission computed tomography/CT improves preoperative planning and facilitates detection, thus enhancing the clinical value of the SLN technique and improving the oncologic safety of surgery.
authors.affiliation: *Department of Obstetrics and Gynecology, †Institut of Biometry, ‡Tumour Centre, §Institute of Pathology, and ∥Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Hertel
authors.forename: Philipp
authors.initials: P
authors.lastname: Soergel
authors.forename: Johanna
authors.initials: J
authors.lastname: Muecke
authors.forename: Michael
authors.initials: M
authors.lastname: Schneider
authors.forename: Frank
authors.initials: F
authors.lastname: Papendorf
authors.forename: Florian
authors.initials: F
authors.lastname: Laenger
authors.forename: Klaus-Friedrich
authors.initials: KF
authors.lastname: Gratz
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
mesh_terms: D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014625:Vaginal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid