J Korean Orthop Assoc.  2019 Dec;54(6):509-518. 10.4055/jkoa.2019.54.6.509.

The Efficacy of Detecting a Sentinel Lymph Node through Positron Emission Tomography/Computed Tomography

• Shin DS
• Na HD
• Park JW

• KMID: 2469882
• DOI: http://doi.org/10.4055/jkoa.2019.54.6.509

Abstract

PURPOSE
Lymph node metastasis is a very important prognostic factor for all skin cancers and some sarcomas. A sentinel lymph node (SLN) biopsy is the most useful technique for identifying SLNs. Recently, a new generation of diagnostic tools, such as single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/CT (PET/CT) enabled the detection of SLNs. This study compared the efficacy of PET/CT for detecting lymph node metastases with a SLN biopsy in a single medical center.
MATERIALS AND METHODS
From 2008 to 2018, 72 skin cancers of sarcoma patients diagnosed with some lymph node involvement in a whole body PET/CT reading were assessed. Patients suspected of lymph node metastasis were sent to biopsy and those suspected to be reactive lesions were observed. The analysis was performed retrospectively using the medical records, clinical information, PET/CT readings, and pathology results.
RESULTS
The age of patients ranged from 14 to 88 years and the mean follow-up period was 2.4 years. Twenty-two patients were suspected of a lymph node metastasis and confirmed. The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT images in sarcoma and non-sarcoma tumors were increased significantly when the expert's findings were considered together.
CONCLUSION
PET/CT is effective in detecting lymph node metastases.

Keyword

skin neoplasm; sarcoma; sentinel lymph node; positron emission tomography/computed tomography

MeSH Terms

Biopsy
Electrons*
Follow-Up Studies
Humans
Lymph Nodes*
Medical Records
Neoplasm Metastasis
Pathology
Positron-Emission Tomography and Computed Tomography
Reading
Retrospective Studies
Sarcoma
Sensitivity and Specificity
Skin Neoplasms

Figure

• 

  Figure 1 Concepts of the study. All patients diagnosed with malignant tumor underwent positron emission tomography/computed tomography (PET/CT) and lymph node metastases were evaluated through a sentinel lymph node biopsy and clinical course.

Reference

1. Kawada K, Taketo MM. Significance and mechanism of lymph node metastasis in cancer progression. Cancer Res. 2011; 71:1214–1218.

2. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992; 127:392–399.

3. Gershenwald JE, Tseng CH, Thompson W, et al. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery. 1998; 124:203–210.

4. Alex JC, Weaver DL, Fairbank JT, Rankin BS, Krag DN. Gamma-probe-guided lymph node localization in malignant melanoma. Surg Oncol. 1993; 2:303–308.

5. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994; 220:391–398. discussion 398-401.

6. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Ann Surg Oncol. 2012; 19:3313–3324.

7. Matthey-Giè ML, Boubaker A, Letovanec I, Demartines N, Matter M. Sentinel lymph node biopsy in nonmelanoma skin cancer patients. J Skin Cancer. 2013; 2013:267474.

8. Ross AS, Schmults CD. Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg. 2006; 32:1309–1321.

9. Liu YY, Rozen WM, Rahdon R. Sentinel lymph node biopsy for squamous cell carcinoma of the extremities: case report and review of the literature. Anticancer Res. 2011; 31:1443–1446.

10. Renzi C, Caggiati A, Mannooranparampil TJ, et al. Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature. Eur J Surg Oncol. 2007; 33:364–369.

11. Allen PJ, Bowne WB, Jaques DP, Brennan MF, Busam K, Coit DG. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005; 23:2300–2309.

12. Ames SE, Krag DN, Brady MS. Radiolocalization of the sentinel lymph node in Merkel cell carcinoma: a clinical analysis of seven cases. J Surg Oncol. 1998; 67:251–254.

13. Gupta SG, Wang LC, Peñas PF, Gellenthin M, Lee SJ, Nghiem P. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: the Dana-Farber experience and meta-analysis of the literature. Arch Dermatol. 2006; 142:685–690.

14. Zembowicz A, Carney JA, Mihm MC. Pigmented epithelioid melanocytoma: a low-grade melanocytic tumor with metastatic potential indistinguishable from animal-type melanoma and epithelioid blue nevus. Am J Surg Pathol. 2004; 28:31–40.

15. Magro CM, Crowson AN, Mihm MC Jr, Gupta K, Walker MJ, Solomon G. The dermal-based borderline melanocytic tumor: a categorical approach. J Am Acad Dermatol. 2010; 62:469–479.

16. Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003; 10:676–680.

17. Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg. 1993; 217:72–77.

18. Blazer DG 3rd, Sabel MS, Sondak VK. Is there a role for sentinel lymph node biopsy in the management of sarcoma? Surg Oncol. 2003; 12:201–206.

19. Nowecki ZI, Rutkowski P, Nasierowska-Guttmejer A, Ruka W. Sentinel lymph node biopsy in melanoma patients with clinically negative regional lymph nodes: one institution's experience. Melanoma Res. 2003; 13:35–43.

20. Thompson JF, McCarthy WH, Bosch CM, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res. 1995; 5:255–260.

21. Doting MH, Hoekstra HJ, Plukker JT, et al. Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma. Eur J Surg Oncol. 2002; 28:673–678.

22. McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: controversy despite widespread agreement. J Clin Oncol. 2001; 19:2851–2855.

23. Rutkowski P, Nowecki ZI, Nasierowska-Guttmejer A, Ruka W. Lymph node status and survival in cutaneous malignant melanoma--sentinel lymph node biopsy impact. Eur J Surg Oncol. 2003; 29:611–618.

24. Wagner JD, Schauwecker D, Davidson D, et al. Prospective study of fluorodeoxyglucose-positron emission tomography imaging of lymph node basins in melanoma patients undergoing sentinel node biopsy. J Clin Oncol. 1999; 17:1508–1515.

25. Rinne D, Baum RP, Hör G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer. 1998; 82:1664–1671.

26. El-Maraghi RH, Kielar AZ. PET vs sentinel lymph node biopsy for staging melanoma: a patient intervention, comparison, outcome analysis. J Am Coll Radiol. 2008; 5:924–931.

27. Weingrad DN, Rosenberg SA. Early lymphatic spread of osteogenic and soft-tissue sarcomas. Surgery. 1978; 84:231–240.

28. Mazeron JJ, Suit HD. Lymph nodes as sites of metastases from sarcomas of soft tissue. Cancer. 1987; 60:1800–1808.

29. Ross HM, Lewis JJ, Woodruff JM, Brennan MF. Epithelioid sarcoma: clinical behavior and prognostic factors of survival. Ann Surg Oncol. 1997; 4:491–495.

30. Halling AC, Wollan PC, Pritchard DJ, Vlasak R, Nascimento AG. Epithelioid sarcoma: a clinicopathologic review of 55 cases. Mayo Clin Proc. 1996; 71:636–642.