title: Value and advantages of preoperative sentinel lymph node imaging with SPECT/CT in cervical cancer.
abstract: OBJECTIVE
  Precise detection of sentinel lymph nodes (SLNs) seems to be a crucial factor for optimized treatment of cervical cancer. We assess the use of single photon emission computed tomography combined with computed tomography (SPECT/CT) as an alternative to lymphoscintigraphy (LSG) for preoperative identification of SLN.
  
  
  METHODS
  This study was performed in a prospective, unicentric setting. Patients with cervical carcinoma were scheduled for surgery and additional SLN labeling by peritumoral injection of 10 MBq technetium-99m-nanocolloid and patent blue. Thirty minutes after injection, LSG and SPECT/CT were carried out. We evaluated the number of SLNs detected intraoperatively in LSG and SPECT/CT and the histologic findings of SLN and non-SLN. Subsequently, we determined the impact of these results on the therapeutic approach.
  
  
  RESULTS
  This represents the largest study about SPECT/CT for SLN detection in cervical cancer so far. Between August 2008 and March 2013, 59 cervical cancer patients underwent intraoperative SLN detection. In addition, 51 of these patients underwent preoperative LSG and SPECT/CT. Imaging with SPECT/CT detected singular SLN at significantly higher rate (47/51, 92.2%) than that with planar LSG (43/51, 84.3%, P = 0.044). Furthermore, SPECT/CT performed better than LSG regarding the total number of detected SLN (SPECT/CT median, 3 [0-18]; LSG median, 2 [0-15]) and detection rates per pelvic side (SPECT/CT 76.9%, LSG 69.2%, P < 0.01). Whenever SLN detection succeeded, histologic evaluation of SLN correctly predicted the lymph node status per patient's side. Using this type of diagnostic approach for lymph node staging, we reached sensitivity of 100% and negative predictive value of 100% at a rate of false-negative results of 0% even in tumors larger than 4 cm.
  
  
  CONCLUSIONS
  Single photon emission computed tomography combined with computed tomography imaging leads to improved rates of SLN detection and better anatomic correlation compared with planar LSG. Thus, intraoperative detection of SLN can be improved by preoperative SPECT/CT imaging. This enhances the clinical value of SLN technique and improves the oncologic safety of SLN concept.
authors.affiliation: *Department of Obstetrics and Gynecology, †Institute of Biometry, ‡Institute of Pathology, and §Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Klapdor
authors.forename: Johanna
authors.initials: J
authors.lastname: Mücke
authors.forename: Michael
authors.initials: M
authors.lastname: Schneider
authors.forename: Florian
authors.initials: F
authors.lastname: Länger
authors.forename: Klaus-Friedrich
authors.initials: KF
authors.lastname: Gratz
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.forename: Hermann
authors.initials: H
authors.lastname: Hertel
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging*