Vol 21, No 2 (2018)
Research paper
Published online: 2018-06-08

open access

Page views 2796
Article views/downloads 1126
Get Citation

Connect on Social Media

Connect on Social Media

Value of planar lymphoscintigraphy (PL) versus SPECT/CT in evaluation of sentinel lymph node in trunk melanoma — one center, large series retrospective study

Małgorzata Benke1, Krzysztof Wocial1, Weronika Lewandowska1, Piotr Rutkowski2, Paweł Teterycz2, Piotr Jarek3, Marek Dedecjus1
Pubmed: 29956817
Nucl. Med. Rev 2018;21(2):79-84.


BACKGROUND: Localization and histopathological examination of sentinel lymph node is a standard of melanoma treatment. The first stage of identification of the SLN is the preoperative lymphoscintigraphy. The aim of this study was to assess and compare diagnostic value of planar lymphoscintigraphy and SPECT/CT in sentinel lymph node biopsy procedure performed in patients with cutaneous trunk melanoma.

MATERIAL AND METHODS: Between 2015 and 2016, patients with trunk melanoma (N = 255, F/M 95/160), aged from 17 to 88 after an excisional biopsy, with primary tumor ≥ pT1b (AJCC 2009, median Breslow thickness 2.0 ± 3.13) were included in the study. In all the patients PL was followed by SPECT/CT 1–3 hours after injection of 99mTc- colloid particles, and SLNB was performed the next day.

RESULTS: SPECT-CT revealed 78 (18.6%) SLN more than PL, and in 40 patients showed additional lymph drainage regions leading to surgical adjustments. In 18 patients (7.1%) SPECT-CT revealed SLN not visible in the PL (false-negative PL) and in 22 patients (8.6%), foci of uptake interpreted in PL as hot SLNs were found to be non-nodal sites of uptake when assessed on SPECT/CT (false positive PL). SPECT-CT vs. PL mismatch was observed in 31 patients (12.2%) and was the most common in patients with primary lesions located in the anterior inferior medial region (75%).

CONCLUSIONS: Results of the presented study indicates the high diagnostic value of SPECT-CT in assessment of SLNs and proved that SPECT-CT increases the sensitivity and accuracy of SLN identification as compared to PL even in very experienced hands.

Article available in PDF format

View PDF Download PDF file


  1. Erdei E, Torres SM. A new understanding in the epidemiology of melanoma. Expert Rev Anticancer Ther. 2010; 10(11): 1811–1823.
  2. Bluemel C, Herrmann K, Giammarile F, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging. 2015; 42(11): 1750–1766.
  3. Gould E, Winship T, Philbin P, et al. Observations on a “sentinel node” in cancer of the parotid. Cancer. 1960; 13(1): 77–78, doi: 10.1002/1097-0142(196001/02)13:1<77::aid-cncr2820130114>3.0.co;2-d.
  4. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977; 39(2): 456–466, doi: 10.1002/1097-0142(197702)39:2<456::aid-cncr2820390214>3.0.co;2-i.
  5. Alex JC, Krag DN. Gamma-probe guided localization of lymph nodes. Surg Oncol. 1993; 2(3): 137–143.
  6. Marone U, Aloj L, Di Monta G, et al. Lymphoscintigraphy defines new lymphatic pathways from cutaneous melanoma site: clinical implications and surgical management. Radiol Res Pract. 2011; 2011: 817043.
  7. Vucetić B, Andreja Rogan S, Balenović A, et al. The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma. Wien Klin Wochenschr. 2006; 118(9-10): 286–293.
  8. Manganoni AM, Farfaglia R, Sereni E, et al. Interval sentinel lymph nodes: an unusual localization in patients with cutaneous melanoma. Dermatol Res Pract. 2011; 2011: 506790.
  9. Alazraki NP, Eshima D, Eshima LA, et al. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers. Semin Nucl Med. 1997; 27(1): 55–67.
  10. Straver ME, Meijnen P, van Tienhoven G, et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial. Ann Surg Oncol. 2010; 17(7): 1854–1861.
  11. Giammarile F, Bozkurt MF, Cibula D, et al. The EANM clinical and technical guidelines for lymphoscintigraphy and sentinel node localization in gynaecological cancers. Eur J Nucl Med Mol Imaging. 2014; 41(7): 1463–1477.
  12. Intenzo CM, Truluck CA, Kushen MC, et al. Lymphoscintigraphy in cutaneous melanoma: an updated total body atlas of sentinel node mapping. Radiographics. 2009; 29(4): 1125–1135.
  13. Dummer R, Hauschild A, Lindenblatt N, et al. ESMO Guidelines Committee. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26 Suppl 5: v126–v132.
  14. Wong SL, Balch CM, Hurley P, et al. American Society of Clinical Oncology, Society of Surgical Oncology. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012; 30(23): 2912–2918.
  15. Kraft O, Havel M. Localisation of sentinel lymph nodes in patients with melanomas by planar lymphoscintigraphic and hybrid SPECT/CT imaging. Nucl Med Rev Cent East Eur. 2012; 15(2): 101–107.
  16. Jimenez-Heffernan A, Ellmann A, Sado H, et al. Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies. J Nucl Med. 2015; 56(9): 1338–1344.
  17. Wanebo HJ, Harpole D, Teates CD. Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk. Cancer. 1985; 55(6): 1403–1413, doi: 10.1002/1097-0142(19850315)55:6<1403::aid-cncr2820550640>3.0.co;2-k.
  18. Reynolds HM, Walker CG, Dunbar PR, et al. Functional anatomy of the lymphatics draining the skin: a detailed statistical analysis. J Anat. 2010; 216(3): 344–355.
  19. Uren RF, Howman-Giles RB, Shaw HM, et al. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med. 1993; 34(9): 1435–1440.
  20. Uren RF, Howman-Giles R, Thompson JF. Patterns of lymphatic drainage from the skin in patients with melanoma. J Nucl Med. 2003; 44(4): 570–582.
  21. El Muntasar A, Oudit D. Lymphoscintigraphy mapping of truncal malignant melanoma: A study of 212 patients at the Christie NHS Foundation Trust. J Plast Reconstr Aesthet Surg. 2017; 70(1): 37–39.
  22. Brewster DH, Horner MJD, Rowan S, et al. Left-sided excess of invasive cutaneous melanoma in six countries. Eur J Cancer. 2007; 43(18): 2634–2637.
  23. Even-Sapir E, Lerman H, Lievshitz G, et al. Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT system. J Nucl Med. 2003; 44(9): 1413–1420.
  24. Kretschmer L, Altenvoerde G, Meller J, et al. Dynamic lymphoscintigraphy and image fusion of SPECT and pelvic CT-scans allow mapping of aberrant pelvic sentinel lymph nodes in malignant melanoma. Eur J Cancer. 2003; 39(2): 175–183.
  25. van der Ploeg IMC, Valdés Olmos RA, Kroon BBR, et al. The yield of SPECT/CT for anatomical lymphatic mapping in patients with melanoma. Ann Surg Oncol. 2009; 16(6): 1537–1542.
  26. Duce V, Manca G, Mazzarri S, et al. Sentinel Node Mapping in Melanoma of the Back: SPECT/CT Helps Discriminate. Clin Nucl Med. 2016; 41(1): e66–e67.
  27. Brammen L, Nedomansky J, Haslik W, et al. Extraordinary Lymph Drainage in Cutaneous Malignant Melanoma and the Value of Hybrid Imaging: A Case Report. Nucl Med Mol Imaging. 2014; 48(4): 306–308.
  28. Ozguven S, Gungor S, Aras M, et al. Clinical Impact of Preoperative Sentinel Lymph Node Imaging With SPECT/CT in the Management of Interscapular Malignant Melanoma. Clin Nucl Med. 2015; 40(9): 762–763.
  29. Voinea S, Sandru A, Gherghe M, et al. -. Pitfalls in Cutaneous Melanoma Lymphatic Drainage. Chirurgia (Bucur). 2016; 111(1): 87–89.
  30. Tew K, Farlow D. SPECT/CT in Melanoma Lymphoscintigraphy. Clin Nucl Med. 2016; 41(12): 961–963.
  31. Doepker MP, Yamamoto M, Applebaum MA, et al. Comparison of Single-Photon Emission Computed Tomography-Computed Tomography (SPECT/CT) and Conventional Planar Lymphoscintigraphy for Sentinel Node Localization in Patients with Cutaneous Malignancies. Ann Surg Oncol. 2017; 24(2): 355–361.
  32. Veenstra HJ, Vermeeren L, Olmos RA, et al. The additional value of lymphatic mapping with routine SPECT/CT in unselected patients with clinically localized melanoma. Ann Surg Oncol. 2012; 19(3): 1018–1023.
  33. McHugh JB, Su L, Griffith KA, et al. Significance of multiple lymphatic basin drainage in truncal melanoma patients undergoing sentinel lymph node biopsy. Ann Surg Oncol. 2006; 13(9): 1216–1223.
  34. Fitzgerald TL, Gronet EM, Atluri P, et al. Patterns of node mapping differ for axial and extremity primary cutaneous melanoma: A case for a more selective use of pre-operative imaging. Surgeon. 2016; 14(4): 190–195.
  35. Rutkowski P, Szydłowski K, Nowecki ZI, et al. The long-term results and prognostic significance of cutaneous melanoma surgery using sentinel node biopsy with triple technique. World J Surg Oncol. 2015; 13: 299.
  36. Ribero S, Osella-Abate S, Dika E, et al. Prognostic role of histological regression in cutaneous melanoma. G Ital Dermatol Venereol. 2017; 152(6): 638–641.
  37. Tardelli E, Mazzarri S, Rubello D, et al. Sentinel Lymph Node Biopsy in Cutaneous Melanoma: Standard and New Technical Procedures and Clinical Advances. A Systematic Review of the Literature. Clin Nucl Med. 2016; 41(12): e498–e507.