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Am J Nucl Med Mol Imaging 2013;3(2):182-193
Original Article
Added-value of SPECT/CT to lymphatic mapping and sentinel lym-phadenectomy
in gynaecological cancers
Tarik Z Belhocine, Michel Prefontaine, Dominique Lanvin, Monique Bertrand, Irina Rachinsky, Helen Ettler, Pamela Zabel, Larry W
Stitt, Akira Sugimoto, Jean-Luc Urbain
Department of Medical Imaging-Nuclear Medicine, Western University, London, ON, Canada; Department of Gynaecology Oncology,
Western University, London, ON, Canada; Department of Pathology, Western University, London, ON, Canada; Statistical Services,
London, ON, Canada
Received December 11, 2012; Accepted December 28, 2012; Epub March 8, 2013; Published March 18, 2013
Abstract: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been successfully used in pre-treatment nodal staging
of gynae-cological cancers. We hypothesised the added-value of LM/SL plus SPECT/CT in patients with early stage of cervical cancer
and vulvar cancer. A prospective, single-center, diagnostic, open label, active control, non-randomized clinical trial has been
conducted in 7 patients with FIGO IA-IB1 cervical cancer and 7 patients with FIGO stage I-II-IIIcN0 vulvar cancer. All patients
underwent LM/SL plus SPECT/low-dose CT and complete lymph node dissection (CLND) according to the standard of care. In case
of negative hematoxylin-eosin staining, serial sections of the SLNs were analysed by immunohistochemistry and high molecular
weight cytokeratin. Primary outcome measures were the detection rate, the sensitivity (SV), the negative predictive value (NPV), the
diagnostic accuracy (DA) for anatomic localisation of SLNs, and the impact on management of SPECT/CT guided LM/SL versus
CLND. The secondary outcome measure was the patient tolerability and operating time of LM/SL guided SPECT/CT versus CLND.
http://clinicaltrials.gov/show/NCT00773071 All 14 patients were enrolled into the 1-day research protocol with dual-tracer LM/SL and
SPECT/CT. Additional SLNs were detected on SPECT/CT compared to conventional planar imaging. Hot and cold > 1cm SLNs were
detected on SPECT/CT. Detection rate, SV, NPV, DA were 100% in both groups; false negative rate was 0%. Rate of SLN metastases
was 28.5% in cervical cancer and 42.9% in vulvar cancer. Impact on treatment was 28.5% and 14.3% in cervical cancer and vulvar
cancer patients, respectively. SPECT/CT was well tolerated by all patients and operating time for LM/SL was within 30 min. No
adverse events were reported with a time frame of 1-to-3 years. In early stage of gynaecological cancers, SPECT/low-dose CT is
technically feasible and of clinical added-value for LM/SL. (ajnmmi1212001)
Keywords: LM/SL, SPECT/CT, vulvar cancer, cervical cancer
Address correspondence to: Dr. Tarik Z Belhocine, Department of Medical Imaging - Nuclear Medicine, Western University –
London, ON, Canada. Tel: 519-685-8500; Fax: 519-646-6403; E-mail: tbelhocine@yahoo.ca
Original Article
Added-value of SPECT/CT to lymphatic mapping and sentinel lym-phadenectomy
in gynaecological cancers
Tarik Z Belhocine, Michel Prefontaine, Dominique Lanvin, Monique Bertrand, Irina Rachinsky, Helen Ettler, Pamela Zabel, Larry W
Stitt, Akira Sugimoto, Jean-Luc Urbain
Department of Medical Imaging-Nuclear Medicine, Western University, London, ON, Canada; Department of Gynaecology Oncology,
Western University, London, ON, Canada; Department of Pathology, Western University, London, ON, Canada; Statistical Services,
London, ON, Canada
Received December 11, 2012; Accepted December 28, 2012; Epub March 8, 2013; Published March 18, 2013
Abstract: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been successfully used in pre-treatment nodal staging
of gynae-cological cancers. We hypothesised the added-value of LM/SL plus SPECT/CT in patients with early stage of cervical cancer
and vulvar cancer. A prospective, single-center, diagnostic, open label, active control, non-randomized clinical trial has been
conducted in 7 patients with FIGO IA-IB1 cervical cancer and 7 patients with FIGO stage I-II-IIIcN0 vulvar cancer. All patients
underwent LM/SL plus SPECT/low-dose CT and complete lymph node dissection (CLND) according to the standard of care. In case
of negative hematoxylin-eosin staining, serial sections of the SLNs were analysed by immunohistochemistry and high molecular
weight cytokeratin. Primary outcome measures were the detection rate, the sensitivity (SV), the negative predictive value (NPV), the
diagnostic accuracy (DA) for anatomic localisation of SLNs, and the impact on management of SPECT/CT guided LM/SL versus
CLND. The secondary outcome measure was the patient tolerability and operating time of LM/SL guided SPECT/CT versus CLND.
http://clinicaltrials.gov/show/NCT00773071 All 14 patients were enrolled into the 1-day research protocol with dual-tracer LM/SL and
SPECT/CT. Additional SLNs were detected on SPECT/CT compared to conventional planar imaging. Hot and cold > 1cm SLNs were
detected on SPECT/CT. Detection rate, SV, NPV, DA were 100% in both groups; false negative rate was 0%. Rate of SLN metastases
was 28.5% in cervical cancer and 42.9% in vulvar cancer. Impact on treatment was 28.5% and 14.3% in cervical cancer and vulvar
cancer patients, respectively. SPECT/CT was well tolerated by all patients and operating time for LM/SL was within 30 min. No
adverse events were reported with a time frame of 1-to-3 years. In early stage of gynaecological cancers, SPECT/low-dose CT is
technically feasible and of clinical added-value for LM/SL. (ajnmmi1212001)
Keywords: LM/SL, SPECT/CT, vulvar cancer, cervical cancer
Address correspondence to: Dr. Tarik Z Belhocine, Department of Medical Imaging - Nuclear Medicine, Western University –
London, ON, Canada. Tel: 519-685-8500; Fax: 519-646-6403; E-mail: tbelhocine@yahoo.ca
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