Isthmocervical labelling and SPECT/CT for optimized sentinel detection in endometrial cancer: technique, experience and results.
OBJECTIVE
We evaluated the clinical feasibility of a new injection technique for sentinel detection in endometrial carcinoma (EC), transcervical subepithelial injection into the isthmocervical region of the myometrium. We compared detection of sentinel lymph nodes (SLN) by single photon emission computed tomography with CT (SPECT/CT) with planar lymphoscintigraphy.


METHODS
This is a unicentric prospective study. In all patients, transcervical injection of 10 MBq Technetium-99m-nanocolloid was performed into the isthmocervical myometrium without anaesthesia. After 40 (30-60) min, lymphoscintigraphy and SPECT/CT were performed. Patent blue was administered before surgery. The number and localisation of SLN detected in SPECT/CT and lymphoscintigraphy were recorded and compared to the SLN and non-SLN dissected intra-operatively.


RESULTS
Between August 2008 and March 2012, 31 patients with EC were enrolled. The new transcervical injection of labelling substances led to high intra-operative (90.3%) detection rates, pelvic bilateral (57%), para-aortic (25%). SPECT/CT significantly identified more SLN than lymphoscintigraphy (mean 2.2 (1-8) to 1.3 (1-7)) in more patients (29/31 (93.5%) to 21/31 (68%), p<0.01). If SLN were identified in one hemi-pelvis, the histological evaluation of the SLN correctly predicted lymph node (LN) metastases for this basin which led to sensitivity 100%, negative predictive value (NPV) 100%, and false negative results 0%.


CONCLUSIONS
Transcervical SLN marking in combination with SPECT/CT is easily applicable and leads to high physiologic detection rates in pelvic and para-aortic lymphatic drainage areas. Non-affected SLN truly predicted a non-affected LN basin. Combining both methods SLN dissection may be a safe and feasible staging technique for clinical routine in EC.
Department of Obstetrics and Gynaecology, Hannover Medical School, Germany.
J
J
Mücke
Department of Obstetrics and Gynaecology, Hannover Medical School, Germany.
R
R
Klapdor
Institute of Biometry, Hannover Medical School, Germany.
M
M
Schneider
Institute of Pathology, Hannover Medical School, Germany.
F
F
Länger
Department of Nuclear Medicine, Hannover Medical School, Germany.
K F
KF
Gratz
Department of Obstetrics and Gynaecology, Hannover Medical School, Germany.
P
P
Hillemanns
Department of Obstetrics and Gynaecology, Hannover Medical School, Germany. Electronic address: hertel.hermann@mh-hannover.de.
H
H
Hertel
D000328:Adult; D000368:Aged; D002584:Cervix Uteri; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D061305:Lymphoscintigraphy / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
Endometrial carcinoma; Lymphoscintigraphy; SPECT/CT; Sentinel concept; Transcervical application