title: SPECT/CT Improves Detection of Metastatic Sentinel Lymph Nodes in Patients with Head and Neck Melanoma.
abstract: A positive sentinel lymph node (SLN) is the most important prognostic factor for predicting survival in cutaneous melanoma. This study aimed to evaluate how the addition of single-photon emission computed tomography (SPECT) and computed tomography (CT) to planar lymphoscintigraphy (PL) alters SLN identification, yield, and localization of metastatic nodes in head and neck melanoma.
  
  
  
  This retrospective review examined patients undergoing SLN biopsy for cutaneous melanoma of the head and neck between July 2003 and December 2015. Patient demographics and pathologic outcomes were compared for patients undergoing SPECT-CT versus PL. A multivariable logistic regression analysis was used to identify factors associated with the identification of a positive SLN.
  
  
  
  Among 176 patients undergoing SLN biopsy, 91 underwent PL and 85 underwent SPECT-CT and PL. The patients in the SPECT-CT group were older than the PL patients (p = 0.050) but the groups did not differ in gender (p = 0.447), Breslow thickness (p = 0.744), or total number of SLNs identified (p = 0.633). As shown by the multivariate regression analysis, only Breslow thickness [odds ratio (OR) 1.47; 95 % confidence interval (CI) 1.17-1.84] and SPECT-CT (OR 3.58; 95 % CI 1.24-10.4) were associated with a positive SLN.
  
  
  
  The use of SPECT-CT for patients with head and neck cutaneous melanoma significantly increases the likelihood of retrieving a positive SLN. Long-term follow-up evaluation is needed for further definition of the impact that SPECT-CT has on recurrence and survival.
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Brandon C
authors.initials: BC
authors.lastname: Chapman
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Gleisner
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kwak
authors.affiliation: Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hosokawa
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Paniccia
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Merkow
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Koo
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Csaba
authors.initials: C
authors.lastname: Gajdos
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Pearlman
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: McCarter
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. nicole.kounalakis@ucdenver.edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kounalakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D000096142:Cutaneous Malignant Melanoma