title: Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies.
abstract: We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors.
  
  
  METHODS
  From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day.
  
  
  RESULTS
  Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer.
  
  
  CONCLUSIONS
  SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.
authors.affiliation: Hospital Juan Ramon Jimenez, Huelva, Spain.
authors.forename: Amelia
authors.initials: A
authors.lastname: Jimenez-Heffernan
authors.affiliation: Stellenbosch University, Tygerberg Hospital, Stellenbosch, South Africa.
authors.forename: Annare
authors.initials: A
authors.lastname: Ellmann
authors.affiliation: Instituto Do Cancer de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Heitor
authors.initials: H
authors.lastname: Sado
authors.affiliation: University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Dražen
authors.initials: D
authors.lastname: Huić
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Chandrasekhar
authors.initials: C
authors.lastname: Bal
authors.affiliation: Manipal Hospital, Bangalore, India.
authors.forename: Ramanathapuram
authors.initials: R
authors.lastname: Parameswaran
authors.affiliation: Hospices Civils, University of Lyon 1, Lyon, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giammarile
authors.affiliation: Fundacion Arturo Lopez Perez, Santiago, Chile.
authors.forename: Rossana
authors.initials: R
authors.lastname: Pruzzo
authors.affiliation: University Hospital Alexandrovska, Sofia, Bulgaria.
authors.forename: Irena
authors.initials: I
authors.lastname: Kostadinova
authors.affiliation: Pretoria Academic Hospital, Pretoria, South Africa.
authors.forename: Mariza
authors.initials: M
authors.lastname: Vorster
authors.affiliation: Real Hospital Português, Recife, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Almeida
authors.affiliation: St. Lukes Medical Center, Quezon City, Philippines.
authors.forename: Jonas
authors.initials: J
authors.lastname: Santiago
authors.affiliation: Sanjay Gandhi Institute of Medical Sciences, Lucknow, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gambhir
authors.affiliation: Sofia Cancer Center, Sofia, Bulgaria.
authors.forename: Sonya
authors.initials: S
authors.lastname: Sergieva
authors.affiliation: Instituto Nacional de Cancerlologia, Bogota, Colombia.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Calderon
authors.affiliation: Universidade de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Gabriela Oh
authors.initials: GO
authors.lastname: Young
authors.affiliation: The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Renato
authors.initials: R
authors.lastname: Valdes-Olmos
authors.affiliation: IAEA, Vienna, Austria; and.
authors.forename: John
authors.initials: J
authors.lastname: Zaknun
authors.affiliation: University of the Philippines Manila, Manila, Philippines.
authors.forename: Vincent Peter
authors.initials: VP
authors.lastname: Magboo
authors.affiliation: IAEA, Vienna, Austria; and T.Pascual@iaea.org.
authors.forename: Thomas N B
authors.initials: TN
authors.lastname: Pascual
mesh_terms: D005260:Female; D006801:Humans; D007390:International Agencies; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009369:Neoplasms / Q000175:diagnosis*; D011877:Radionuclide Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: SPECT/CT; breast cancer; melanoma; pelvic cancer; sentinel node