TY - JOUR
T1 - Technological (R)Evolution leads to detection of more sentinel nodes in patients with melanoma in the head and neck region
AU - Berger, Danique M. S.
AU - van den Berg, N. S.
AU - van der Noort, V.
AU - van der Hiel, B.
AU - Olmos, R. A. Valdés
AU - Buckle, T. A.
AU - KleinJan, G. H.
AU - Brouwer, O. R.
AU - Vermeeren, L.
AU - Karakullukçu, B.
AU - van den Brekel, M. W. M.
AU - van de Wiel, B. A.
AU - Nieweg, O. E.
AU - Balm, A. J. M.
AU - van Leeuwen, F. W. B.
AU - Klop, W. M. C.
N1 - Funding Information: This work is, in part, supported by the Netherlands Organization for Scientific Research: Rubicon grant (019.171LW.022), VIDI grant (STW BGT11272) and a VICI grant (AES BGT 16141) and a European research council-starting grant (ERC-2012-StG-306890). Funding Information: part, supported by Publisher Copyright: © 2021 Society of Nuclear Medicine Inc.. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background Sentinel lymph node (SN) biopsy (SLNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technological refinements, including the introduction of single photon emission computed tomography combined with computed tomography (SPECT/CT) as well as radio- and fluorescence-guidance. The purpose of the current study was to evaluate the effect of this technological evolution on SLNB in the head and neck region. Primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN and postoperative complications. Patients and Methods A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SLNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided in 4 groups: (1) 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a gamma ray detection probe and patent blue (n=30); (2) 2006-2007, with addition of preoperative roadmaps based on SPECT/CT (n=15); (3) 2008-2009, with intraoperative use of a portable gamma camera (n=40); and (4) 2010-2016, with the addition of near-infrared fluorescence guidance (n=192). Results A total of 277 patients were included. At least one SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%), 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%) and 40 in group 4 (20.8%). Regional recurrences of patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (FN groups 1: 16.7%; 2: 0%; 3: 14.3%; 4: 11.1%). The number of harvested nodes increased with advancing technologies (p=0.003) whereas Breslow thickness and operation time per harvested SN decreased (p=0.003 and p=0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time and complication rate between the different groups. Conclusion The use of advanced detection technologies led to a higher number of identified SNs without increase in overall operation time, which may indicate an improved surgical efficiency. Operation time per harvested SN decreased, the average FN rate remained 11.9% and unchanged over 23 years. There was no significant change in postoperative complication rate.
AB - Background Sentinel lymph node (SN) biopsy (SLNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technological refinements, including the introduction of single photon emission computed tomography combined with computed tomography (SPECT/CT) as well as radio- and fluorescence-guidance. The purpose of the current study was to evaluate the effect of this technological evolution on SLNB in the head and neck region. Primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN and postoperative complications. Patients and Methods A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SLNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided in 4 groups: (1) 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a gamma ray detection probe and patent blue (n=30); (2) 2006-2007, with addition of preoperative roadmaps based on SPECT/CT (n=15); (3) 2008-2009, with intraoperative use of a portable gamma camera (n=40); and (4) 2010-2016, with the addition of near-infrared fluorescence guidance (n=192). Results A total of 277 patients were included. At least one SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%), 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%) and 40 in group 4 (20.8%). Regional recurrences of patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (FN groups 1: 16.7%; 2: 0%; 3: 14.3%; 4: 11.1%). The number of harvested nodes increased with advancing technologies (p=0.003) whereas Breslow thickness and operation time per harvested SN decreased (p=0.003 and p=0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time and complication rate between the different groups. Conclusion The use of advanced detection technologies led to a higher number of identified SNs without increase in overall operation time, which may indicate an improved surgical efficiency. Operation time per harvested SN decreased, the average FN rate remained 11.9% and unchanged over 23 years. There was no significant change in postoperative complication rate.
KW - False negative
KW - Head and neck
KW - Melanoma
KW - Sentinel lymph node biopsy
KW - false-negative; head and neck; melanoma; sentinel lymph node biopsy
UR - http://www.scopus.com/inward/record.url?scp=85106561564&partnerID=8YFLogxK
U2 - https://doi.org/10.2967/jnumed.120.246819
DO - https://doi.org/10.2967/jnumed.120.246819
M3 - Article
C2 - 33637591
SN - 0161-5505
VL - 62
SP - 1357
EP - 1362
JO - Journal of nuclear medicine
JF - Journal of nuclear medicine
IS - 10
ER -