The Efficacy of Radionuclide Imaging Techniques at Sentinel Node Identification in Patients with Cutaneous Melanoma

Purpose: To evaluate and compare the diagnostic efficacy of the planar lymphoscintigraphy, SPECT (SPECT/CT) and intraoperative detection with handheld gamma-probe in the identification of the sentinel lymph node (SLN) among patients with melanoma.

Material and methods: 324 patients with cutaneous melanoma who underwent treatment at N.N. Blokhin National Medical Research Center of Oncology between 2018 and 2020, were included in this study. For SLN identification lymphoscintigraphy (n = 324) and SPECT (SPECT/CT) (n = 259) images were obtained preoperatively after injection of 99mTc-labeled colloid particles. Lymphatic mapping was implemented with permanent skin marker designating the anatomical landmarks of sentinel node’s location. Additionally, SLN localization was identified by handheld gamma-probe (n = 294). The status of the remote sentinel lymph node was determined by a histological assessment considered as the gold standard.

Results: SPECT (SPECT/CT) provided additional information in 67 patients (25.8 %) with planar lymphoscintigraphy: in 45 cases it revealed more SLN within the same regional lymphatic drainage basin, and in 22 (8.5 %) showed additional (lymphatic drainage) basin or unusual drainage pattern. In 10 patients (3.9 %) SPECT/CT revealed SLN not visible in the planar lymphoscintigraphy (false-negative). False SLN identification results were detected mostly in patients with head and neck melanoma. The overall rate of surgical approach modification in the total group is 10.4 % (10 patients among 259), the additional information provided by SPECT (SPECT/CT) impacted management and surgical planning in 11 (37.9 %) of 29 patients of head and neck melanoma group.

Analysis of planar lymphoscintigraphic imaging, tomographic imaging (SPECT and SPECT/CT), and intraoperative detection revealed a sensitivity and PPV of 95.6, 100, 100 % and 98.7, 97.7, 96.9 %, respectively.

Conclusion: Radionuclide imaging techniques are reliable and account for the current need for navigating the surgical access when performing a sentinel lymph node biopsy. SPECT and SPECT/CT visualizes more sentinel nodes than conventional images, reduces false-negative rate and improved anatomical location of sentinel nodes. The diagnostic effi of SPECT and SPECT/CT is superior to the static lymphoscintigraphy in sentinel lymph node detection due to the better sensitivity (100 and 95.6 %, respectively) with a similar positive predictive value PPV (97.7 and 98.7 %, respectively). These advantages may lead to a surgical adjustment in a considerable number of patients, especially in the head and neck melanoma.

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