Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region.

Autor:	Berger DMS; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; d.berger@nki.nl m.klop@nki.nl., van den Berg NS; Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California., van der Noort V; Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van der Hiel B; Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Valdés Olmos RA; Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Buckle TA; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., KleinJan GH; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands., Brouwer OR; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Vermeeren L; Department of Otorhinolaryngology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Karakullukçu B; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van den Brekel MWM; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van de Wiel BA; Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands; and., Nieweg OE; Melanoma Institute Australia and Central Medical School, University of Sydney, Sydney, Australia., Balm AJM; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van Leeuwen FWB; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands., Klop WMC; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2021 Oct; Vol. 62 (10), pp. 1357-1362. Date of Electronic Publication: 2021 Feb 26.
DOI:	10.2967/jnumed.120.246819
Abstrakt:	Sentinel lymph node (SN) biopsy (SNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technologic refinements, including the introduction of SPECT/CT, as well as radioguidance and fluorescence guidance. The purpose of the current study was to evaluate the effect of this technologic evolution on SNB in the head and neck region. The 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. Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided into 4 groups: 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a γ-ray detection probe and patent blue ( n = 30); 2006-2007, with addition of preoperative road maps based on SPECT/CT ( n = 15); 2008-2009, with intraoperative use of a portable γ-camera ( n = 40); and 2010-2016, with addition of near-infrared fluorescence guidance ( n = 192). Results: In total, 277 patients were included. At least 1 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 in patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (group 1, 16.7%; group 2, 0%; group 3, 14.3%; group 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 an increase in overall operation time, possibly indicating an improved surgical efficiency. Operation time per harvested SN decreased; the average FN rate remained 11.9% and was unchanged over 23 y. There was no significant change in postoperative complication rate. (© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)
Databáze:	MEDLINE
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