SPECT/CT Technique Provides Improved Detection of Lymph Node Metastasis in Patients with Melanoma

Preoperative three-dimensional (3D) visualization of sentinel lymph nodes (SLNs) used with single-photon emission computed tomography/computed tomography (SPECT/CT) imaging was associated with a higher rate of identification of positive SLNs and a higher rate of disease-free survival among patients with melanoma, according to new findings.

The study’s findings were published in the September 12, 2012, issue of the Journal of the American Medical Association (JAMA). “Melanoma has become an increasing interdisciplinary public health challenge worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Melanoma is the third most common cancer in Australia and the fifth most common cancer in the United States. The American Cancer Society estimated that approximately 70,230 new melanomas were diagnosed in the United States during 2011, resulting in approximately 8,790 deaths,” reported the authors. “Because melanoma, depending on tumor depth, metastasizes early into regional lymph nodes, sentinel lymph node excision [SLNE] is probably the most important diagnostic and potentially therapeutic procedure for patients with melanoma. The histological status of the sentinel lymph node is the most relevant prognostic factor for overall survival in patients with melanoma, independent of primary tumor thickness.”

The investigators added that the recently introduced hybrid SPECT/CT imaging technology could help reduce the high false-negative rate of SLNE by providing additional anatomic data to the surgeon.

Ingo Stoffels, MD, of the University of Essen-Duisburg (Essen, Germany), and colleagues conducted a study to compare the link between SLNE with versus without preoperative SPECT/CT imaging and metastatic node detection and disease-free survival in patients with cutaneous melanoma. The study included use of a melanoma patient database to identify a group of 464 patients eligible for SLNE between March 2003 and April 2011. A total of 403 patients with clinically negative lymph nodes, who underwent SLNE with or without preoperative SPECT/CT, qualified for subsequent analysis. Between March 2003 and October 2008, 254 patients with melanoma underwent SLNE without preoperative SPECT/CT. Between November 2008 and April 2011 all sentinel node scintigraphies were performed as SPECT/CT in 149 patients. Using SPECT/CT allowed SLNE in the head and neck area more frequently (2.0% for standard vs. 23.5% for SPECT/CT).

A total of 833 SLNs were removed from 403 patients. The researchers detected 2.40 SLNs per patient in the SPECT/CT group and 1.87 SLNs per patient in the standard group; 51 of 358 excised SLNs (14.2%) in the SPECT/CT cohort and 54 of 475 SLNs (11.4%) in the standard cohort showed metastatic involvement. The scientists were able to identify 41 patients (27.5%) with positive SLNs in the SPECT/CT cohort and 48 (18.9%) with positive SLNs in the standard cohort. The number of positive SLNs per patient was significantly higher in the SPECT/CT cohort than in the standard cohort (0.34 vs. 0.21).

“The local relapse rate in the SPECT/CT cohort was lower than in the standard cohort (6.8% vs. 23.8%), which prolonged four-year disease-free survival (93.9% vs. 79.2%),” reported the researchers.

The researchers noted that with the SPECT/CT technique, they were able to use smaller incisions in the head and neck area as well as alternative entry points due to the exact anatomic localization of the SLN.

“In conclusion, the preoperative visualization of SLN with SPECT/CT is technically feasible and facilitates the detection of additional positive SLNs. The use of this technique offers the physician the preoperative possibility of determining the exact location and visualization of the SLN…,” the researchers wrote in their article. “In patients with cutaneous melanoma, the use of SPECT/CT-aided SLNE compared with SLNE alone was associated with higher detection of metastatic involvement and a higher rate of disease-free survival.”

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University of Essen-Duisburg