PT  - JOURNAL ARTICLE
AU  - Brouwer, Oscar R.
AU  - Valdés Olmos, Renato A.
AU  - Vermeeren, Lenka
AU  - Hoefnagel, Cornelis A.
AU  - Nieweg, Omgo E.
AU  - Horenblas, Simon
TI  - SPECT/CT and a Portable γ-Camera for Image-Guided Laparoscopic Sentinel Node Biopsy in Testicular Cancer
AID  - 10.2967/jnumed.110.086660
DP  - 2011 Apr 01
TA  - Journal of Nuclear Medicine
PG  - 551--554
VI  - 52
IP  - 4
4099  - http://jnm.snmjournals.org/content/52/4/551.short
4100  - http://jnm.snmjournals.org/content/52/4/551.full
SO  - J Nucl Med2011 Apr 01; 52
AB  - The purpose of this study was to evaluate the utility of SPECT/CT and real-time intraoperative imaging with a portable γ-camera for laparoscopic sentinel node (SN) localization in stage I testicular cancer. Methods: Ten patients with clinical stage I testicular cancer were studied between November 2006 and November 2010. Their mean age was 37 y (range, 25–50 y). The primary tumors were situated on the right side in 5 patients and on the left side in 5. After a funicular block with 2% lidocaine, an average dose of 80 MBq (range, 59–98 MBq) of 99mTc-nanocolloid in a volume of 0.2 mL was injected into the testicular parenchyma. Shortly after injection, a 10-min dynamic study was performed, followed by the acquisition of static planar images at 15 min and 2 h. SPECT/CT was performed at 2 h. After image fusion, SNs were visualized, and their exact anatomic location was determined. The SPECT/CT images were displayed in the operation room to guide SN detection using a laparoscopic γ-ray probe and a portable γ-camera. Results: Lymphatic drainage to the retroperitoneum was seen in all patients. SPECT/CT identified interaortocaval or paracaval SNs in the 5 patients with right-sided tumors, one of whom had an additional SN adjacent to the testicular vessels. In all 5 patients with left-sided tumors, paraaortic SNs were visualized; a node along the testicular vessels was visualized in 2 of these 5. Twenty-six SNs were laparoscopically removed (range, 1–4 per patient). An SN contained metastases in 1 case. No recurrences developed in the 9 patients with a tumor-free SN during a median follow-up of 21 mo (range, 2–50 mo). Conclusion: SPECT/CT enables accurate anatomic localization of retroperitoneal SNs in patients with testicular cancer, facilitating their laparoscopic retrieval. Real-time image guidance by a portable γ-camera improves intraoperative SN detection and appears to identify (20%) additional SNs.