RT Journal Article
SR Electronic
T1 Paraaortic Sentinel Lymph Nodes: Toward Optimal Detection and Intraoperative Localization Using SPECT/CT and Intraoperative Real-Time Imaging
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 376
OP 382
DO 10.2967/jnumed.109.071779
VO 51
IS 3
A1 Lenka Vermeeren
A1 Willem Meinhardt
A1 Axel Bex
A1 Henk G. van der Poel
A1 Wouter V. Vogel
A1 Cees A. Hoefnagel
A1 Simon Horenblas
A1 Renato A. Valdés Olmos
YR 2010
UL http://jnm.snmjournals.org/content/51/3/376.abstract
AB Paraaortic sentinel node biopsy may be a challenging procedure because the sentinel nodes are located retroperitoneally in close proximity to vital structures. The purpose of this study was to describe and evaluate the value of preoperative SPECT/CT for lymphatic mapping, and a portable γ-camera for intraoperative radioguidance, in patients with paraaortic sentinel nodes. Methods: We evaluated our practice in 18 patients, who were treated at The Netherlands Cancer Institute with sentinel lymphadenectomy for different urologic malignancies and showed paraaortic drainage on preoperative images. After intratumoral injection of 99mTc-nanocolloid, the patients underwent sequential planar lymphoscintigraphy, hybrid SPECT/CT, and sentinel lymphadenectomy. Intraoperative node detection and localization were guided by a laparoscopic γ-probe and a portable γ-camera. This γ-camera was set to display both the 99mTc signal and the 125I-seed signal. This 125I seed was placed on top of the γ-probe, functioning as a pointer on screen, thus enabling real-time sentinel node localization with the γ-camera. Results: In 16 patients with midabdominal drainage on planar images and in 2 patients with nonvisualization on planar images, SPECT/CT showed clear localization of paraaortic sentinel nodes in relation to the abdominal vessels. Five patients underwent open surgery, and 13 patients underwent laparoscopy. The paraaortic sentinel nodes were successfully localized and removed in 15 patients with the help of the portable γ-camera and γ-probe and in 3 patients with the γ-probe only. In 1 patient, the paraaortic sentinel node showed a metastasis. Conclusion: If retroperitoneal drainage is expected, SPECT/CT provides good detection and clear localization of sentinel nodes in relation to anatomic structures. Detection and removal of paraaortic sentinel nodes by means of a laparoscopic γ-probe and real-time imaging with a portable γ-camera is a successful method with high intraoperative detection rates.