• Amelia Jimenez-Heffernan, Annare Ellmann, Heitor Sado, Dražen Huić, Chandrasekhar Bal, Ramanathapuram Parameswaran, Francesco Giammarile, Rossana Pruzzo, Irena Kostadinova, Mariza Vorster, Paulo Almeida, Jonas Santiago, Sanjay Gambhir, Sonya Sergieva, Alvaro Calderon, Gabriela Oh Young, Renato Valdes-Olmos, John Zaknun, Vincent Peter Magboo, and Thomas N B Pascual.
• Hospital Juan Ramon Jimenez, Huelva, Spain.
• J. Nucl. Med. 2015 Sep 1; 56 (9): 1338-44.

UnlabelledWe aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors.MethodsFrom 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day.ResultsSignificantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer.ConclusionSPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.© 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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