Hybrid SPECT-CT: an additional technique for sentinel node detection of patients with invasive bladder cancer.

OBJECTIVES To explore the feasibility of performing lymphoscintigraphy combined with computed tomography (CT) for preoperative detection of sentinel lymph nodes in patients with invasive bladder cancer. MATERIALS Six consecutive patients scheduled for radical cystectomy underwent lymphoscintigraphy after transurethral injection of Albures-technetium 99m in the detrusor muscle peritumourally both with planar imaging and with single-photon emission computed tomography/CT (SPECT/CT). CT for anatomic fusion was performed directly after the SPECT/CT and both investigations were combined to a fused image. Radical cystectomy started with extended lymphadenectomy and intraoperative detection of sentinel nodes with both Geiger probe and dye marker. The conventional planar lymphoscintigraphies and the fused SPECT/CT were compared with each other and with the outcome of intraoperative sentinel node detection and final histopathologic analyses. RESULTS The method allowed anatomically detailed preoperative visualisation of 21 sentinel nodes in five of the six patients, whereas planar pictures only visualised two sentinel nodes in two of six patients. Two patients had lymph node metastases and in the other four the nodes were negative. The combined method visualised all metastatic sentinel nodes, whereas planar lymphoscintigraphy detected only one of six node metastases. CONCLUSIONS The combination of lymphoscintigraphy with CT enhanced preoperative anatomic localisation of sentinel nodes in bladder cancer and aided in the identification of sentinel nodes during surgery. The yield of detected sentinel nodes, both metastatic and nonmetastatic, was markedly increased using the combined method compared to conventional planar lymphoscintigraphy.

[1]  K. Alitalo,et al.  Lymphangiogenesis and Cancer , 2004, Cancer Research.

[2]  P. Malmström,et al.  Lymphatic mapping and detection of sentinel nodes in patients with bladder cancer. , 2001, The Journal of urology.

[3]  W Becker,et al.  Dynamic lymphoscintigraphy and image fusion of SPECT and pelvic CT-scans allow mapping of aberrant pelvic sentinel lymph nodes in malignant melanoma. , 2003, European journal of cancer.

[4]  Roland Bares,et al.  549 Anatomic-functional image fusion allows intraoperative sentinel node detection in prostate cancer patients , 2004 .

[5]  M. Fukuda,et al.  Fusion of SPECT and multidetector CT images for accurate localization of pelvic sentinel lymph nodes in prostate cancer patients. , 2005, Journal of nuclear medicine technology.

[6]  S. Kropf,et al.  Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. , 2004, The Journal of urology.

[7]  G. Chebil,et al.  Intraoperative sentinel node detection improves nodal staging in invasive bladder cancer. , 2006, The Journal of urology.

[8]  L. Mortelmans,et al.  FDG-PET for preoperative staging of bladder cancer , 2005, European Journal of Nuclear Medicine and Molecular Imaging.

[9]  M. Ghoneim,et al.  Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a patho-anatomical study--a single center experience. , 2004, The Journal of urology.

[10]  P. Tanis,et al.  The Definition of a Sentinel Node , 2001, Annals of Surgical Oncology.

[11]  R. Foster,et al.  The sentinel node in breast cancer--a multicenter validation study. , 1998, The New England journal of medicine.

[12]  M. Ghoneim,et al.  Lymphadenectomy with cystectomy: is it necessary and what is its extent? , 2004, European urology.

[13]  P. Malmström,et al.  Re: extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. , 2004, The Journal of urology.

[14]  G. Schwartz Clinical Practice Guidelines for the Use of Axillary Sentinel Lymph Node Biopsy in Carcinoma of the Breast: Current Update , 2004, The breast journal.

[15]  E. Even-Sapir,et al.  Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT system. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[16]  U. Studer,et al.  Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. , 2002, The Journal of urology.

[17]  K. Wester,et al.  Early metastatic progression of bladder carcinoma: molecular profile of primary tumor and sentinel lymph node. , 2002, The Journal of urology.

[18]  P. Bassi,et al.  Prognostic factors of outcome after radical cystectomy for bladder cancer: a retrospective study of a homogeneous patient cohort. , 1999, The Journal of urology.

[19]  M. Ross,et al.  Recent advances in the care of the patient with malignant melanoma. , 1997, Annals of surgery.

[20]  P. Ell,et al.  Clinical role of sentinel-lymph-node biopsy in breast cancer. , 2002, The Lancet. Oncology.

[21]  Kurt Schicho,et al.  SPECT-CT for topographic mapping of sentinel lymph nodes prior to gamma probe-guided biopsy in head and neck squamous cell carcinoma. , 2004, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[22]  S. Muller,et al.  Reliability of lymphoscintigraphy in indicating the number of sentinel nodes in melanoma patients , 2000, Annals of Surgical Oncology.

[23]  F. Liedberg,et al.  Lymph node metastasis in bladder cancer. , 2006, European urology.

[24]  R. Jain,et al.  Lymphatics Make the Break , 2003, Science.