Značenje jednofotonske emisijske tomografije i kompjuterizirane tomografije u otkrivanju limfnog čvora "čuvara" u bolesnika s karcinomom dojke i malignim melanomom [The value of single photon emission tomography and computed tomograpy in detection of sentinel lymph node in breast cancer and melanoma patients]

Mutvar, Andrea (2017) Značenje jednofotonske emisijske tomografije i kompjuterizirane tomografije u otkrivanju limfnog čvora "čuvara" u bolesnika s karcinomom dojke i malignim melanomom [The value of single photon emission tomography and computed tomograpy in detection of sentinel lymph node in breast cancer and melanoma patients]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: lymph node status is one of the most important prognostic factors for recurrence and survival in malignant melanoma and breast cancer patients in early stage disease. Sentinel node biopsy is a standard procedure in staging regional lymph nodes in those patients. SPECT/CT is new, hybrid imaging technique that can improve visualization and localization of sentinel node. The aim of this prospective study was to assess the contribution and additional value of SPECT / CT imaging in detection and biopsy of the sentinel lymph node in malignant melanoma and breast cancer patients. Method: from December 2010 to September 2015, the study included 166 patients, 79 patients with breast cancer and 87 patients with malignant melanoma of the skin. After intradermal or peritumoral administration of radiopharmaceuticals (99mTc - colloid) all patients underwent planar scintigraphy (dynamic and static imaging) according to usual protocol (one-day or two-day protocol) and SPECT / CT immediately after the last planar imaging. All participants signed an informed consent. Result: SPECT/CT showed statistically higher number of sentinel lymph nodes in relation to the number of sentinel nodes detected by planar scintigraphy in both groups. In the group of patients with malignant melanoma SPECT / CT showed a 17.5% sentinel nodes more than planar scintigraphy in 37.9% of patients and in the group of patients with breast cancer 13% sentinel nodes more in 20.3% of patients. Identification and localization of sentinel lymph nodes was more accurate by SPECT/CT imaging than planar scintigraphy. We noted identical findings of SPECT/CT and planar scintigraphy in 52.9% of melanoma patients and 72.1% breast cancer patients. The positive impact of SPECT / CT was observed in 42.5% of malignant melanoma and 48.1% of breast cancer patients. Conclusion: Hybrid tomographic imaging technique that combines two imaging methods, SPECT and CT, has significant advantages over planar scintigraphy in the detection of sentinel lymph node. We recommend it to be a part of the standard protocol for sentinel lymph node detection and biopsy in all melanoma and breast cancer patients.

Abstract in Croatian

Uvod: Status limfnih čvorova jedan je od najvažnijih prognostičkih čimbenika za povrat bolesti i preživljenje oboljelih od malignog melanoma ili karcinoma dojke u ranom stadiju bolesti. Biopsija sentinel čvora danas je standardni postupak za procjenu proširenosti bolesti u regionalne limfne čvorove u ovih bolesnika. SPECT/CT je nova, hibridna tehnika snimanja koja može poboljšati vizualizaciju i lokalizaciju sentinel čvora. Cilj je ovog prospektivnog istraživanja procijeniti korist i doprinos dodatnog SPECT/CT snimanja u detekciji sentinel limfnog čvora u oboljelih od malignog melanoma i karcinoma dojke. Metoda: Od prosinca 2010. do rujna 2015. u istraživanje je uključeno ukupno 166 ispitanika, 79 bolesnica s karcinomom dojke i 87 bolesnika s malignim melanomom kože. Nakon intradermalne ili peritumorske aplikacije radiofarmaka (99mTc koloid) u svih je ispitanika učinjena planarna scintigrafija (dinamička i statička scintigrafija) sentinel limfnog čvora prema uobičajenom protokolu (jednodnevni ili dvodnevni protokol), a neposredno nakon zadnjega konvencionalnog snimanja učinjen je SPECT/CT. Svi ispitanici potpisali su informirani pristanak prije početka pretrage. Rezultat: SPECT/CT je otkrio statistički značajno veći broj sentinel čvorova u odnosu na broj sentinel čvorova otkrivenih planarnom scintigrafijom u obje skupine ispitanika. U skupini bolesnika s malignim melanomom SPECT/CT je otkrio 17,5 % više sentinel limfnih čvorova u 37,9 % bolesnika u odnosu na planarnu scintigrafiju, a u skupini bolesnica s karcinomom dojke 13 % sentinel limfnih čvorova više nego planarna scintigrafija u 20,3 % bolesnica. Identifikacija i lokalizacija sentinel čvorova bila je znatno preciznija SPECT/CT snimanjem nego planarnom scintigrafijom. Podudaran nalaz SPECT/CT-a i planarne scintigrafije uočili smo u 52,9 % bolesnika s melanomom i 72,1 % bolesnica s karcinomom dojke. Pozitivan utjecaj SPECT/CT-a primijećen je u 42,5 % bolesnika s malignim melanomom i 48,1 % bolesnica s karcinomom dojke. Zaključak: Hibridna tomografska tehnika snimanja koja objedinjuje dvije slikovne metode, SPECT i CT, ima znatne prednosti pred planarnom scintigrafijom u detekciji sentinel limfnog čvora i savjetujemo da se uvrsti u standardni protokol scintigrafije sentinel limfnog čvora u svih bolesnika s melanomom i bolesnica s karcinomom dojke.

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