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Utility of Quantitative SPECT/CT Lymphoscintigraphy in Guiding Sentinel Lymph Node Biopsy in Head and Neck Melanoma

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the use of advanced SPECT/CT quantification in guiding surgical selection of positive sentinel lymph nodes (SLNs) in head and neck melanoma.

Methods

We retrospectively reviewed data from patients with cutaneous head and neck melanoma who underwent lymphoscintigraphy with SPECT/CT prior to SLN biopsy (SLNB). Quantification of radiotracer uptake from SPECT/CT data was performed using in-house segmentation software. SLNs identified using SPECT/CT were compared to SLNs identified surgically using an intraoperative γ-probe. A radioactivity count threshold using SPECT/CT for detecting a positive SLN was calculated.

Results

One hundred and five patients were included. Median number of SLNs detected was 3/patient with SPECT/CT and 2/patient with intraoperative γ-probe. The hottest node identified by SPECT/CT and intraoperative γ-probe were identical in 85% of patients. All 20 histologically positive SLNs were identified by SPECT/CT and γ-probe. On follow-up, all nodal recurrences occurred at lymph node levels with the hottest node identified by SPECT/CT and either the hottest or second hottest node identified by γ-probe during SLNB. Using our data, a SPECT/CT radioactivity count threshold of 20% would eliminate the unnecessary removal of 11% of SPECT/CT identified nodes and 12% of intraoperatively detected nodes.

Conclusion

Utilizing SPECT/CT quantification, we propose that a radioactivity count threshold can be developed to help guide the selective removal of lymph nodes in head and neck SLNB. Furthermore, the nodal level containing the hottest node identified by SPECT/CT quantification must be thoroughly investigated for SLNs and undergo careful follow-up and surveillance for recurrence.

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Authors and Affiliations

  1. Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA

    Jennifer J. Kwak MD, Alexandria Jensen MS & Rustain L. Morgan MD

  2. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Adam L. Kesner PhD

  3. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Ana Gleisner MD, Chloe Friedman MPH & Martin D. McCarter MD

  4. Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA

    Alexandria Jensen MS

  5. Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Gilbert, AZ, USA

    Phillip J. Koo MD

  6. Melanoma and Sarcoma Specialists of Georgia, Northside Hospital, Atlanta, GA, USA

    Nicole Kounalakis MD

Authors
  1. Jennifer J. Kwak MD
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  2. Adam L. Kesner PhD
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  3. Ana Gleisner MD
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  4. Alexandria Jensen MS
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  5. Chloe Friedman MPH
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  6. Martin D. McCarter MD
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  7. Phillip J. Koo MD
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  8. Rustain L. Morgan MD
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  9. Nicole Kounalakis MD
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Corresponding author

Correspondence to Jennifer J. Kwak MD.

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Kwak, J.J., Kesner, A.L., Gleisner, A. et al. Utility of Quantitative SPECT/CT Lymphoscintigraphy in Guiding Sentinel Lymph Node Biopsy in Head and Neck Melanoma. Ann Surg Oncol 27, 1432–1438 (2020). https://doi.org/10.1245/s10434-019-08078-0

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  • DOI: https://doi.org/10.1245/s10434-019-08078-0

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