title: Pericervical Injection of 99mTc-Nanocolloid Is Superior to Peritumoral Injection for Sentinel Lymph Node Detection of Endometrial Cancer in SPECT/CT.
abstract: OBJECTIVE
  Scintigraphic mapping of sentinel lymph node (SLN) is increasingly performed in patients with endometrial carcinoma although its routine clinical use is still under investigation. The purpose of this study was to compare preoperative SLN detection by means of SPECT/CT using pericervical (PC) versus hysteroscopic peritumoral (PT) injection.
  
  
  METHODS
  One hundred forty consecutive patients with endometrial carcinoma who underwent surgery and preoperative SLN SPECT/CT with Tc-nanocolloid were included. Seventy women received hysteroscopic injection at 3 PT sites, and 70 women received PC injection at 3-, 6-, 9-, and 12-o'clock positions. Each patient underwent SPECT/CT followed by modified radical hysterectomy with lymphadenectomy on the day after. Histopathological results were collected for validation.
  
  
  RESULTS
  Three hundred thirty-four SLNs were detected by SPECT/CT in 106 patients (mean, 3.15; range, 1-9). The detection rate after PC nanocolloid injection was 83% versus 69% after PT injection (Pearson χ test, P = 0.049). However, PT application resulted in a higher rate of para-aortic SLNs (PC: 60% vs PT: 38% of positive scans, P = 0.02). SPECT/CT yielded an overall sensitivity of 70% for the SLN detection in women with lymph node metastases with 3 false-negative cases. Failure to detect SLN was mostly associated with uptake in the reticuloendothelial system (liver, spleen, and bone marrow) or peritoneal diffusion in both cohorts. Negative scans after PT application often showed a minor to even failing injection depot.
  
  
  CONCLUSIONS
  Pericervical injection leads to a significantly better detection rate of SLN on SPECT/CT while reducing invasiveness of the injection procedure. Failure to detect SLN seems to be associated with major venous drainage.
authors.affiliation: From the Departments of *Nuclear Medicine and Clinical Molecular Imaging, †Gynecology and Obstetrics, and ‡Pathology, University Hospital Tübingen; §Department of Gynecology and Obstetrics, University Hospital Frankfurt; and ∥Department of Gynecology and Obstetrics, University Hospital Homburg, Germany.
authors.forename: Samine
authors.initials: S
authors.lastname: Sahbai
authors.forename: Florin-Andrei
authors.initials: FA
authors.lastname: Taran
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiz
authors.forename: Annette
authors.initials: A
authors.lastname: Staebler
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
authors.forename: Erich
authors.initials: E
authors.lastname: Solomayer
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.forename: Christian
authors.initials: C
authors.lastname: la Fougère
authors.forename: Sara
authors.initials: S
authors.lastname: Brucker
authors.forename: Helmut
authors.initials: H
authors.lastname: Dittmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007267:Injections; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid