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European Journal of Nuclear Medicine and Molecular Imaging
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 13/2015

01.12.2015 | Original Article

The use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer: possible implications for the extent of inguinal lymph node dissection

verfasst von: Angela Collarino, Maarten L. Donswijk, Willemien J. van Driel, Marcel P. Stokkel, Renato A. Valdés Olmos

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 13/2015

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Abstract

Purpose

To determine the lymphatic drainage pattern using SPECT/CT in clinically node-negative (cN0) patients with vulvar cancer, and to evaluate the possible implications for the extent of inguinal lymph node dissection.

Methods

A total of 83 patients with vulvar cancer scheduled for sentinel node (SN) biopsy were injected peritumorally with radioactive nanocolloid particles followed by lymphoscintigraphy and SPECT/CT for anatomical localization. The SN and higher-echelon nodes on SPECT/CT were located in different zones in the groin and pelvic region. The groin was divided into five zones according to Daseler et al.: four zones obtained by drawing two perpendicular lines over the saphenofemoral junction and one zone directly overlying this junction. The nodes in the pelvic region were classified into three zones: external iliac/obturator, the common iliac and the paraaortic zones.

Results

A total of 217 SNs and 202 higher-echelon nodes were localized on SPECT/CT. All SNs were located in the five zones according to Daseler et al.: 149 (69 %) in the medial superior region, 31 (14 %) in the medial inferior region, 22 (10 %) in the central region, 14 (6.5 %) in the lateral superior region and only 1 (0.5 %) in the lateral inferior region. The higher-echelon nodes were located both in the groin (15 %) and in the pelvic region (85 %).

Conclusion

In patients with cN0 vulvar cancer, lymphatic drainage occurs predominantly to the medial regions of the groin. Drainage to the lateral inferior region of the groin is only incidental and in SN-positive patients this zone might be spared in subsequent extended lymph node dissection. This may lead to a decrease in the morbidity associated with this procedure. SPECT/CT is able to personalize lymphatic mapping, providing detailed information about the number and anatomical location of SNs for adequate surgical planning in the groin.
Literatur
1.
Schuurman MS, van den Einden LC, Massuger LF, Kiemeney LA, van der Aa MA, de Hullu JA. Trends in incidence and survival of Dutch women with vulvar squamous cell carcinoma. Eur J Cancer. 2013;49(18):3872–80.CrossRefPubMed
2.
3.
van der Avoort IA, Shirango H, Hoevenaars BM, Grefte JM, de Hullu JA, de Wilde PC, et al. Vulvar squamous cell carcinoma is a multifactorial disease following two separate and independent pathways. Int J Gynecol Pathol. 2006;25(1):22–9.CrossRefPubMed
4.
Burger MP, Hollema H, Emanuels AG, Krans M, Pras E, Bouma J. The importance of the groin node status for the survival of T1 and T2 vulval carcinoma patients. Gynecol Oncol. 1995;57(3):327–34.CrossRefPubMed
5.
Saito T, Kato K. Management of lymph nodes in the treatment of vulvar cancer. Int J Clin Oncol. 2007;12(3):187–91.CrossRefPubMed
6.
Van der Zee AG, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26(6):884–9.CrossRefPubMed
7.
Paredes P, Vidal-Sicart S. Preoperative and intraoperative lymphatic mapping for radioguided sentinel node biopsy in cancers of the female reproductive system. In: Mariani G, Manca G, Orsini P, Vidal-Sicart S, Valdés Olmos R, editors. Atlas of lymphoscintigraphy and sentinel node mapping. Milan: Springer; 2012. p. 249–68.
8.
Levenback C, Burke TW, Gershenson DM, Morris M, Malpica A, Ross MI. Intraoperative lymphatic mapping for vulvar cancer. Obstet Gynecol. 1994;84(2):163–7.PubMed
9.
Meads C, Sutton AJ, Rosenthal AN, Małysiak S, Kowalska M, Zapalska A, et al. Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis. Br J Cancer. 2014;110(12):2837–46.PubMedCentralCrossRefPubMed
10.
Nieweg OE, Tanis PJ, Kroon BB. The definition of a sentinel node. Ann Surg Oncol. 2001;8(6):538–41.CrossRefPubMed
11.
Mathéron HM, van den Berg NS, Brouwer OR, Kleinjan GH, van Driel WJ, Trum JW, et al. Multimodal surgical guidance towards the sentinel node in vulvar cancer. Gynecol Oncol. 2013;131(3):720–5.CrossRefPubMed
12.
Giammarile F, Bozkurt MF, Cibula D, Pahisa J, Oyen WJ, Paredes P, et al. The EANM clinical and technical guidelines for lymphoscintigraphy and sentinel node localization in gynaecological cancers. Eur J Nucl Med Mol Imaging. 2014;41(7):1463–77.CrossRefPubMed
13.
Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet. 1948;87(6):679–94.PubMed
14.
Leijte JA, Valdés Olmos RA, Nieweg OE, Horenblas S. Anatomical mapping of lymphatic drainage in penile carcinoma with SPECT-CT: implications for the extent of inguinal lymph node dissection. Eur Urol. 2008;54(4):885–90.CrossRefPubMed
15.
Rob L, Robova H, Pluta M, Strnad P, Kacirek J, Skapa P, et al. Further data on sentinel lymph node mapping in vulvar cancer by blue dye and radiocolloid Tc99. Int J Gynecol Cancer. 2007;17(1):147–53.CrossRefPubMed
16.
Coleman RL, Ali S, Levenback CF, Gold MA, Fowler JM, Judson PL, et al. Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173. Gynecol Oncol. 2013;128(2):155–9.PubMedCentralCrossRefPubMed
17.
van der Ploeg IM, Kroon BB, Valdés Olmos RA, Nieweg OE. Evaluation of lymphatic drainage patterns to the groin and implications for the extent of groin dissection in melanoma patients. Ann Surg Oncol. 2009;16(11):2994–9.CrossRefPubMed
18.
Kapteijn BA, Nieweg OE, Petersen JL, Rutgers EJ, Hart AA, van Dongen JA, et al. Identification and biopsy of the sentinel lymph node in breast cancer. Eur J Surg Oncol. 1998;24(5):427–30.CrossRefPubMed
19.
Reintgen D, Cruse CW, Wells K, Berman C, Fenske N, Glass F, et al. The orderly progression of melanoma nodal metastases. Ann Surg. 1994;220(6):759–67.PubMedCentralCrossRefPubMed
20.
Beneder C, Fuechsel FG, Krause T, Kuhn A, Mueller MD. The role of 3D fusion imaging in sentinel lymphadenectomy for vulvar cancer. Gynecol Oncol. 2008;109(1):76–80.CrossRefPubMed
21.
Belhocine TZ, Prefontaine M, Lanvin D, Bertrand M, Rachinsky I, Ettler H, et al. Added-value of SPECT/CT to lymphatic mapping and sentinel lymphadenectomy in gynaecological cancers. Am J Nucl Med Mol Imaging. 2013;3(2):182–93.PubMedCentralPubMed
22.
Kraft O, Havel M. Detection of sentinel lymph nodes in gynecologic tumours by planar scintigraphy and SPECT/CT. Mol Imaging Radionucl Ther. 2012;21(2):47–55.PubMedCentralCrossRefPubMed
23.
Valdés Olmos RA, Rietbergen DD, Vidal-Sicart S, Manca G, Giammarile F, Mariani G. Contribution of SPECT/CT imaging to radioguided sentinel lymph node biopsy in breast cancer, melanoma, and other solid cancers: from “open and see” to “see and open”. Q J Nucl Med Mol Imaging. 2014;58(2):127–39.PubMed
24.
Vidal-Sicart S, Paredes P, Zanón G, Pahisa J, Martinez-Román S, Caparrós X, et al. Added value of intraoperative real-time imaging in searches for difficult-to-locate sentinel nodes. J Nucl Med. 2010;51(8):1219–25.CrossRefPubMed
25.
van den Berg NS, Brouwer OR, Schaafsma BE, Mathéron HM, Klop WM, Balm AJ, et al. Multimodal surgical guidance during sentinel node biopsy for melanoma: combined gamma tracing and fluorescence imaging of the sentinel node through use of the hybrid tracer indocyanine green-99mTc-nanocolloid. Radiology. 2015:275(2):521–9
26.
Brouwer OR, Buckle T, Vermeeren L, Klop WM, Balm AJ, van der Poel HG, et al. Comparing the hybrid fluorescent-radioactive tracer indocyanine green-99mTc-nanocolloid with 99mTc-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and SPECT/CT. J Nucl Med. 2012;53(7):1034–40.CrossRefPubMed
27.
Frontado LM, Brouwer OR, van den Berg NS, Mathéron HM, Vidal-Sicart S, van Leeuwen FW, et al. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Rev Esp Med Nucl Imagen Mol. 2013;32(4):227–33.PubMed
28.
Hefler LA, Grimm C, Six L, Seebacher V, Polterauer S, Joura E, et al. Inguinal sentinel lymph node dissection vs. complete inguinal lymph node dissection in patients with vulvar cancer. Anticancer Res. 2008;28(1B):515–7.PubMed
29.
Robison K, Roque D, McCourt C, Stuckey A, DiSilvestro PA, Sung CJ, et al. Long-term follow-up of vulvar cancer patients evaluated with sentinel lymph node biopsy alone. Gynecol Oncol. 2014;133(3):416–20.CrossRefPubMed
30.
Oonk MH, van Hemel BM, Hollema H, de Hullu JA, Ansink AC, Vergote I, et al. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol. 2010;11:646–52.CrossRefPubMed
Metadaten
Titel
The use of SPECT/CT for anatomical mapping of lymphatic drainage in vulvar cancer: possible implications for the extent of inguinal lymph node dissection
verfasst von
Angela Collarino
Maarten L. Donswijk
Willemien J. van Driel
Marcel P. Stokkel
Renato A. Valdés Olmos
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 13/2015
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-015-3127-1

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