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The sentinel node approach in gynaecological malignancies

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ABSTRACT

This review discusses the state-of-the-art of sentinel lymph node mapping in gynaecological malignancies, including cervical cancer, endometrial cancer, and vulvar cancer, with an emphasis on new technological advances. For this objective, PubMed/MEDLINE was searched for relevant studies about the sentinel lymph node procedure in gynaecology. In particular, the use of preoperative lymphatic mapping with lymphoscintigraphy and single photon emission tomography/computed tomography (SPECT/CT) was identified in 18 studies. Other recent advances as hybrid tracers (e.g. ICG-99mTc-nanocolloid) and intraoperative tools (portable γ-camera and 3D navigation devices) appear to also represent a useful guide for the surgeon during the operation. Concerning vulvar and cervical cancers, the sentinel lymph node procedure has been incorporated to the current guidelines in Europe and North America, whereas for endometrial cancer it is considered investigative.

No MeSH data available.


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Endometrial cancer. Early planar image showed a very faint left node. A lied shield covered the injection area and high activity on the right side was supposed to be a partial zone of the injection area (a). Delayed planar image displays a right sentinel node (red arrow) and the previously observed left sentinel node (blue arrow). 3D volume-rendering image shows the same node distribution like b (c). A more detailed analysis of SPECT/CT data and 3D reconstructed images showed two posterior and caudal nodes (dotted circle) previous to the marked as sentinel node in b corresponding to external iliac nodes during surgery (arrow)
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Fig3: Endometrial cancer. Early planar image showed a very faint left node. A lied shield covered the injection area and high activity on the right side was supposed to be a partial zone of the injection area (a). Delayed planar image displays a right sentinel node (red arrow) and the previously observed left sentinel node (blue arrow). 3D volume-rendering image shows the same node distribution like b (c). A more detailed analysis of SPECT/CT data and 3D reconstructed images showed two posterior and caudal nodes (dotted circle) previous to the marked as sentinel node in b corresponding to external iliac nodes during surgery (arrow)

Mentions: The deep lymphatic drainage of the corpus uteri is a probable reason for the low correlation found between planar lymphoscintigraphy and surgical mapping [38]. This limiting factor may be solved when SPECT/CT is performed in addition to planar images (Fig. 3). This fused SPECT/CT is useful in areas of deep lymphatic drainage, such as the pelvis, providing correction for tissue attenuation with detection of additional SLN(s) in other basins accompanied by accurate anatomical localization. Therefore, preoperative SPECT/CT plays an important role in the planning of surgery and may lead to a decrease of surgical time. Until now, there are few articles reporting the use of SPECT/CT in endometrial cancer [16, 17, 39]. Pandit-Taskar et al. have reported a series, including 40 patients, with endometrial tumour; the authors showed a higher detection rate using SPECT/CT (100 %) compared to a planar lymphoscintigraphy (75 %), a hand-held probe (93 %), and blue dye alone (83 %), and highlighted the ability of SPECT/CT to detect additional SLN(s) in the para-aortic basin [17]. More recently, Naaman et al. reported in 53 endometrial cancer patients that SPECT/CT contributed to increase SLN visualization from 67 %, when only planar lymphoscintigraphy was used, to 84 % when SPECT/CT was included; in this series, anatomical accuracy of SPECT/CT was 91 % [40] (Table 2).Fig. 3


The sentinel node approach in gynaecological malignancies
Endometrial cancer. Early planar image showed a very faint left node. A lied shield covered the injection area and high activity on the right side was supposed to be a partial zone of the injection area (a). Delayed planar image displays a right sentinel node (red arrow) and the previously observed left sentinel node (blue arrow). 3D volume-rendering image shows the same node distribution like b (c). A more detailed analysis of SPECT/CT data and 3D reconstructed images showed two posterior and caudal nodes (dotted circle) previous to the marked as sentinel node in b corresponding to external iliac nodes during surgery (arrow)
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5037154&req=5

Fig3: Endometrial cancer. Early planar image showed a very faint left node. A lied shield covered the injection area and high activity on the right side was supposed to be a partial zone of the injection area (a). Delayed planar image displays a right sentinel node (red arrow) and the previously observed left sentinel node (blue arrow). 3D volume-rendering image shows the same node distribution like b (c). A more detailed analysis of SPECT/CT data and 3D reconstructed images showed two posterior and caudal nodes (dotted circle) previous to the marked as sentinel node in b corresponding to external iliac nodes during surgery (arrow)
Mentions: The deep lymphatic drainage of the corpus uteri is a probable reason for the low correlation found between planar lymphoscintigraphy and surgical mapping [38]. This limiting factor may be solved when SPECT/CT is performed in addition to planar images (Fig. 3). This fused SPECT/CT is useful in areas of deep lymphatic drainage, such as the pelvis, providing correction for tissue attenuation with detection of additional SLN(s) in other basins accompanied by accurate anatomical localization. Therefore, preoperative SPECT/CT plays an important role in the planning of surgery and may lead to a decrease of surgical time. Until now, there are few articles reporting the use of SPECT/CT in endometrial cancer [16, 17, 39]. Pandit-Taskar et al. have reported a series, including 40 patients, with endometrial tumour; the authors showed a higher detection rate using SPECT/CT (100 %) compared to a planar lymphoscintigraphy (75 %), a hand-held probe (93 %), and blue dye alone (83 %), and highlighted the ability of SPECT/CT to detect additional SLN(s) in the para-aortic basin [17]. More recently, Naaman et al. reported in 53 endometrial cancer patients that SPECT/CT contributed to increase SLN visualization from 67 %, when only planar lymphoscintigraphy was used, to 84 % when SPECT/CT was included; in this series, anatomical accuracy of SPECT/CT was 91 % [40] (Table 2).Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

This review discusses the state-of-the-art of sentinel lymph node mapping in gynaecological malignancies, including cervical cancer, endometrial cancer, and vulvar cancer, with an emphasis on new technological advances. For this objective, PubMed/MEDLINE was searched for relevant studies about the sentinel lymph node procedure in gynaecology. In particular, the use of preoperative lymphatic mapping with lymphoscintigraphy and single photon emission tomography/computed tomography (SPECT/CT) was identified in 18 studies. Other recent advances as hybrid tracers (e.g. ICG-99mTc-nanocolloid) and intraoperative tools (portable γ-camera and 3D navigation devices) appear to also represent a useful guide for the surgeon during the operation. Concerning vulvar and cervical cancers, the sentinel lymph node procedure has been incorporated to the current guidelines in Europe and North America, whereas for endometrial cancer it is considered investigative.

No MeSH data available.


Related in: MedlinePlus