A study on the value of computer-assisted assessment for SPECT/CT-scans in sentinel lymph node diagnostics of penile cancer as well as clinical reliability and morbidity of this procedure.
BACKGROUND
Because of the increasing importance of computer-assisted post processing of image data in modern medical diagnostic we studied the value of an algorithm for assessment of single photon emission computed tomography/computed tomography (SPECT/CT)-data, which has been used for the first time for lymph node staging in penile cancer with non-palpable inguinal lymph nodes. In the guidelines of the relevant international expert societies, sentinel lymph node-biopsy (SLNB) is recommended as a diagnostic method of choice. The aim of this study is to evaluate the value of the afore-mentioned algorithm and in the clinical context the reliability and the associated morbidity of this procedure.


METHODS
Between 2008 and 2015, 25 patients with invasive penile cancer and inconspicuous inguinal lymph node status underwent SLNB after application of the radiotracer Tc-99m labelled nanocolloid. We recorded in a prospective approach the reliability and the complication rate of the procedure. In addition, we evaluated the results of an algorithm for SPECT/CT-data assessment of these patients.


RESULTS
SLNB was carried out in 44 groins of 25 patients. In three patients, inguinal lymph node metastases were detected via SLNB. In one patient, bilateral lymph node recurrence of the groins occurred after negative SLNB. There was a false-negative rate of 4 % in relation to the number of patients (1/25), resp. 4.5 % in relation to the number of groins (2/44). Morbidity was 4 % in relation to the number of patients (1/25), resp. 2.3 % in relation to the number of groins (1/44). The results of computer-assisted assessment of SPECT/CT data for sentinel lymph node (SLN)-diagnostics demonstrated high sensitivity of 88.8 % and specificity of 86.7 %.


CONCLUSIONS
SLNB is a very reliable method, associated with low morbidity. Computer-assisted assessment of SPECT/CT data of the SLN-diagnostics shows high sensitivity and specificity. While it cannot replace the assessment by medical experts, it can still provide substantial supplement and assistance.
Department of Nuclear medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), 24105, Kiel, Germany. uluetzen@nuc-med.uni-kiel.de.
Ulf
http://orcid.org/0000-0001-8483-5280
U
Lützen
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
Carsten Maik
CM
Naumann
Department of Nuclear medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), 24105, Kiel, Germany.
Marlies
M
Marx
Department of Nuclear medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), 24105, Kiel, Germany.
Yi
Y
Zhao
Department of Nuclear medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), 24105, Kiel, Germany.
Michael
M
Jüptner
Department of Radiotherapy, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
René
R
Baumann
Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
László
L
Papp
Mediso Ltd., Budapest, Hungary.
Norbert
N
Zsótér
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
Alexey
A
Aksenov
Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
Klaus-Peter
KP
Jünemann
Department of Nuclear medicine, Molecular Imaging Diagnostics and Therapy, University Hospital Schleswig Holstein, Campus Kiel, Feldstr. 21 (Haus 50), 24105, Kiel, Germany.
Maaz
M
Zuhayra
D000328:Adult; D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects* / Q000379:methods; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
CAD; Computer-assisted assessment; Lymph node biopsy; Penile cancer; SPECT/CT; Sentinel lymph nodes; Tc 99 m-nanocolloid