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Missing sentinel lymph node in cutaneous melanoma.

Dellavedova L, Florimonte L, Carletto M, Maffioli LS - Indian J Nucl Med (2015 Apr-Jun)

Bottom Line: Due to the presence on CT co-registered images of another suspicious node (with no radiopharmaceutical uptake) in the crural region, and considering the "high-risk" pathologic features of the removed primary lesion, a 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) staging scan was planned.PET/CT showed high metabolic activity in the suspected crural lymphadenopathy.Histopathology demonstrated massive invasion of the crural ("sentinel") node and no metastatic cells in the inguinal node.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, A. O. Ospedale Civile di Legnano, Legnano, Italy ; Nuclear Medicine Residency, University of Milan, Milano, Italy.

ABSTRACT
The American Society of Clinical Oncology guidelines recommend sentinel lymph node biopsy (SLNB) for all patients with melanoma tumors of intermediate thickness (between 1 and 4 mm). In case of patients with thick melanoma tumors (>4 mm), SLNB may be recommended as well, for staging purposes and to facilitate regional disease control. We report a case of an 82-year-old man, undergone excision of a cutaneous melanoma of the right thigh, which shows some limitation of SLNB in thick melanoma. Lymphoscintigraphy, performed as single-photon emission computed tomography/computed tomography (SPECT/CT), failed to identify the real sentinel lymph node, as tracer uptake was seen in A right inguinal node. Due to the presence on CT co-registered images of another suspicious node (with no radiopharmaceutical uptake) in the crural region, and considering the "high-risk" pathologic features of the removed primary lesion, a 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) staging scan was planned. PET/CT showed high metabolic activity in the suspected crural lymphadenopathy. Histopathology demonstrated massive invasion of the crural ("sentinel") node and no metastatic cells in the inguinal node. This report highlights both the higher accuracy of lymphoscintigraphy, when performed as SPECT/CT and the potential utility of 18F-FDG PET/CT in regional staging.

No MeSH data available.


Related in: MedlinePlus

Volume rendering of technetium-labeled radiocolloids single-photon emission computed tomography/computed tomography (left panel) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (right panel). The arrows show the sites of primary lesion (green), true “sentinel” crural node (red), false “sentinel” inguinal node (yellow)
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Figure 2: Volume rendering of technetium-labeled radiocolloids single-photon emission computed tomography/computed tomography (left panel) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (right panel). The arrows show the sites of primary lesion (green), true “sentinel” crural node (red), false “sentinel” inguinal node (yellow)

Mentions: An 82-year-old white male, with a clinically-confirmed cutaneous melanoma of the right thigh, presented to our unit to undergo lymphoscintigraphy, in order to perform SLNB at the same time of tumor excision. An ultrasonographic evaluation of the lymphatic basin had shown no evidence of adenopathies. Lymphoscintigraphy with 99mTc-nanocolloids was performed on a hybrid system Philips single-photon emission computed tomography/computed tomography (SPECT/CT) Precedence 16 slices (Philips Healthcare, Eindhoven, The Netherlands) after intradermal injection of the radiopharmaceutical around the primary lesion (four separate injections, 0.1 ml for each aliquot, total activity 100 MBq). Low dose helical CT scan was performed: 120 kV, 100 mA, D-DOM control dose, 3 mm slice thickness, 1.5 mm detector collimation, pitch 0.8, rotation time 0.75 s. SPECT scan was acquired with the following parameters: 128 × 128 matrix size, 120 view angle, 10 s time/angle, 5 mm pixel size. SPECT/CT images showed uptake of the radiocolloids in a right inguinal lymph node. On CT co-registered images, anyway, another lymph node with no radiopharmaceutical uptake but with suspicious aspect (globular morphology, absence of hilum) was detectable in the crural region, much closer to the primary tumor [Figures 1 and 2 - left panel].


Missing sentinel lymph node in cutaneous melanoma.

Dellavedova L, Florimonte L, Carletto M, Maffioli LS - Indian J Nucl Med (2015 Apr-Jun)

Volume rendering of technetium-labeled radiocolloids single-photon emission computed tomography/computed tomography (left panel) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (right panel). The arrows show the sites of primary lesion (green), true “sentinel” crural node (red), false “sentinel” inguinal node (yellow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4379679&req=5

Figure 2: Volume rendering of technetium-labeled radiocolloids single-photon emission computed tomography/computed tomography (left panel) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (right panel). The arrows show the sites of primary lesion (green), true “sentinel” crural node (red), false “sentinel” inguinal node (yellow)
Mentions: An 82-year-old white male, with a clinically-confirmed cutaneous melanoma of the right thigh, presented to our unit to undergo lymphoscintigraphy, in order to perform SLNB at the same time of tumor excision. An ultrasonographic evaluation of the lymphatic basin had shown no evidence of adenopathies. Lymphoscintigraphy with 99mTc-nanocolloids was performed on a hybrid system Philips single-photon emission computed tomography/computed tomography (SPECT/CT) Precedence 16 slices (Philips Healthcare, Eindhoven, The Netherlands) after intradermal injection of the radiopharmaceutical around the primary lesion (four separate injections, 0.1 ml for each aliquot, total activity 100 MBq). Low dose helical CT scan was performed: 120 kV, 100 mA, D-DOM control dose, 3 mm slice thickness, 1.5 mm detector collimation, pitch 0.8, rotation time 0.75 s. SPECT scan was acquired with the following parameters: 128 × 128 matrix size, 120 view angle, 10 s time/angle, 5 mm pixel size. SPECT/CT images showed uptake of the radiocolloids in a right inguinal lymph node. On CT co-registered images, anyway, another lymph node with no radiopharmaceutical uptake but with suspicious aspect (globular morphology, absence of hilum) was detectable in the crural region, much closer to the primary tumor [Figures 1 and 2 - left panel].

Bottom Line: Due to the presence on CT co-registered images of another suspicious node (with no radiopharmaceutical uptake) in the crural region, and considering the "high-risk" pathologic features of the removed primary lesion, a 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) staging scan was planned.PET/CT showed high metabolic activity in the suspected crural lymphadenopathy.Histopathology demonstrated massive invasion of the crural ("sentinel") node and no metastatic cells in the inguinal node.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, A. O. Ospedale Civile di Legnano, Legnano, Italy ; Nuclear Medicine Residency, University of Milan, Milano, Italy.

ABSTRACT
The American Society of Clinical Oncology guidelines recommend sentinel lymph node biopsy (SLNB) for all patients with melanoma tumors of intermediate thickness (between 1 and 4 mm). In case of patients with thick melanoma tumors (>4 mm), SLNB may be recommended as well, for staging purposes and to facilitate regional disease control. We report a case of an 82-year-old man, undergone excision of a cutaneous melanoma of the right thigh, which shows some limitation of SLNB in thick melanoma. Lymphoscintigraphy, performed as single-photon emission computed tomography/computed tomography (SPECT/CT), failed to identify the real sentinel lymph node, as tracer uptake was seen in A right inguinal node. Due to the presence on CT co-registered images of another suspicious node (with no radiopharmaceutical uptake) in the crural region, and considering the "high-risk" pathologic features of the removed primary lesion, a 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) staging scan was planned. PET/CT showed high metabolic activity in the suspected crural lymphadenopathy. Histopathology demonstrated massive invasion of the crural ("sentinel") node and no metastatic cells in the inguinal node. This report highlights both the higher accuracy of lymphoscintigraphy, when performed as SPECT/CT and the potential utility of 18F-FDG PET/CT in regional staging.

No MeSH data available.


Related in: MedlinePlus