Preoperative sentinel node mapping with 99mTc-nanocolloid SPECT-CT significantly reduces the intraoperative sentinel node retrieval time in robot assisted laparoscopic cervical cancer surgery

Jacob P. Hoogendam, Monique G G Hobbelink, Wouter B. Veldhuis, René H M Verheijen, Paul J. Van Diest, Ronald P. Zweemer

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To compare preoperative sentinel node (SN) mapping with planar lymphoscintigraphy (LSG) to single photon emission computed tomography with computed tomography (SPECT-CT) for differences in intraoperative SN retrieval time in surgically treated cervical cancer patients. Methods: In cervical cancer patients planned for radical surgery, one day preoperatively, 220-290 MBq technetium-99m-nanocolloid was injected intracervically in four quadrants. Subsequent SN mapping was performed by either LSG (09.2009-03.2011) or SPECT-CT (03.2011-10.2012). The SN resection, by four armed robot assisted laparoscopy, was based on blue dye and technetium-99m and followed by pelvic lymph node dissection. Timing of perioperative care, including SN procedure times, was prospectively registered. Results: Out of the 62 subjects included, 33 (53.2%) underwent LSG and 29 (46.8%) SPECT-CT. No significant differences in baseline characteristics were observed. Bi- and unilateral SN visualization rates were 75.8% and 15.2% for LSG versus 86.2% and 6.9% for SPECT-CT (p = 0.299 and p = 0.305, respectively). Intraoperative bi/unilateral SN detection occurred in 84.8% and 9.1% of LSG subjects versus 89.7% and 3.4% for SPECT-CT (p = 0.573 and p = 0.616). Correlation in SN location between mapping and surgery was low for LSG (Spearman ρ = 0.098; p = 0.449) but high for SPECT-CT (ρ = 0.798; p <0.001). Bilateral intraoperative SN retrieval times for LSG and SPECT-CT were 75.4 ± 33.5 and 50.1 ± 15.6 min, resulting in an average difference of 25.4 min (p = 0.003). Conclusion SPECT-CT significantly reduces intraoperative SN retrieval with a clinically relevant time compared to LSG. The trend towards better bilateral visualization rates and significantly higher anatomical concordance may partly explain the observed difference in SN retrieval time.

Original languageEnglish (US)
Pages (from-to)389-394
Number of pages6
JournalGynecologic Oncology
Volume129
Issue number2
DOIs
StatePublished - May 2013
Externally publishedYes

Keywords

  • Cervical cancer surgery
  • Planar lymphoscintigraphy
  • Preoperative mapping
  • Sentinel node procedure
  • SPECT-CT

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

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