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OtherClinical Investigations (Human)

Technological (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region

Danique Berger, Nynke van den Berg, Vincent van der Noort, Bernies van der Hiel, Renato A. Valdés Olmos, Tessa A. Buckle, Gijs KleinJan, Oscar Roberto Brouwer, Lenka Vermeeren, Baris Karakullukçu, Michiel van den Brekel, Bart van der Wiel, Omgo E Nieweg, Alfons Balm, Fijs E van Leeuwen and Martin Klop
Journal of Nuclear Medicine February 2021, jnumed.120.246819; DOI: https://doi.org/10.2967/jnumed.120.246819
Danique Berger
1 Antoni van Leeuwenhoek, Netherlands;
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Nynke van den Berg
2 Stanford University;
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Vincent van der Noort
1 Antoni van Leeuwenhoek, Netherlands;
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Bernies van der Hiel
3 Netherlands Cancer Institute;
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Renato A. Valdés Olmos
3 Netherlands Cancer Institute;
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Tessa A. Buckle
4 Leiden University Medical Center;
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Gijs KleinJan
1 Antoni van Leeuwenhoek, Netherlands;
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Oscar Roberto Brouwer
3 Netherlands Cancer Institute;
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Lenka Vermeeren
1 Antoni van Leeuwenhoek, Netherlands;
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Baris Karakullukçu
1 Antoni van Leeuwenhoek, Netherlands;
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Michiel van den Brekel
1 Antoni van Leeuwenhoek, Netherlands;
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Bart van der Wiel
1 Antoni van Leeuwenhoek, Netherlands;
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Omgo E Nieweg
5 Melanoma Institute Australia //and// University of Sydney.;
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Alfons Balm
1 Antoni van Leeuwenhoek, Netherlands;
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Fijs E van Leeuwen
6 LUMC
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Martin Klop
1 Antoni van Leeuwenhoek, Netherlands;
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Abstract

Background: Sentinel lymph node (SN) biopsy (SLNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technological refinements, including the introduction of single photon emission computed tomography combined with computed tomography (SPECT/CT) as well as radio- and fluorescence-guidance. The purpose of the current study was to evaluate the effect of this technological evolution on SLNB in the head and neck region. Primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN and postoperative complications. Patients and Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SLNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided in 4 groups: (1) 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a gamma ray detection probe and patent blue (n = 30); (2) 2006-2007, with addition of preoperative roadmaps based on SPECT/CT (n = 15); (3) 2008-2009, with intraoperative use of a portable gamma camera (n = 40); and (4) 2010-2016, with the addition of near-infrared fluorescence guidance (n = 192). Results: A total of 277 patients were included. At least one SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%), 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%) and 40 in group 4 (20.8%). Regional recurrences of patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (FN groups 1: 16.7%; 2: 0%; 3: 14.3%; 4: 11.1%). The number of harvested nodes increased with advancing technologies (P = 0.003) whereas Breslow thickness and operation time per harvested SN decreased (P = 0.003 and P = 0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time and complication rate between the different groups. Conclusion: The use of advanced detection technologies led to a higher number of identified SNs without increase in overall operation time, which may indicate an improved surgical efficiency. Operation time per harvested SN decreased, the average FN rate remained 11.9% and unchanged over 23 years. There was no significant change in postoperative complication rate.

  • Oncology: Head and neck
  • Oncology: Melanoma
  • Radiopharmaceuticals
  • Melanoma
  • false negative
  • head and neck
  • sentinel lymph node biopsy
  • Copyright © 2021 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (4)
Journal of Nuclear Medicine
Vol. 62, Issue 4
April 1, 2021
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Technological (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region
Danique Berger, Nynke van den Berg, Vincent van der Noort, Bernies van der Hiel, Renato A. Valdés Olmos, Tessa A. Buckle, Gijs KleinJan, Oscar Roberto Brouwer, Lenka Vermeeren, Baris Karakullukçu, Michiel van den Brekel, Bart van der Wiel, Omgo E Nieweg, Alfons Balm, Fijs E van Leeuwen, Martin Klop
Journal of Nuclear Medicine Feb 2021, jnumed.120.246819; DOI: 10.2967/jnumed.120.246819

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Technological (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region
Danique Berger, Nynke van den Berg, Vincent van der Noort, Bernies van der Hiel, Renato A. Valdés Olmos, Tessa A. Buckle, Gijs KleinJan, Oscar Roberto Brouwer, Lenka Vermeeren, Baris Karakullukçu, Michiel van den Brekel, Bart van der Wiel, Omgo E Nieweg, Alfons Balm, Fijs E van Leeuwen, Martin Klop
Journal of Nuclear Medicine Feb 2021, jnumed.120.246819; DOI: 10.2967/jnumed.120.246819
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Keywords

  • Oncology: Head and neck
  • Oncology: Melanoma
  • Radiopharmaceuticals
  • Melanoma
  • false negative
  • head and neck
  • Sentinel lymph node biopsy
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