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Higher detection rates, disease free-survival associated with SPECT/CT

Sentinel lymph nodes excised following single-photo emission computed tomography/computed tomography resulted in greater metastatic detection and disease-free survival for patients with melanoma than excision alone, according to study results.

Researchers evaluated 403 patients (mean age, 58.62 years; 60.5% men) with clinically negative sentinel lymph nodes (SLN), who underwent sentinel lymph node excision (SLNE). Two hundred fifty-four patients with melanoma underwent SLNE without hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) between March 2003 and October 2008; 149 had SLNE with SPECT/CT between November 2008 and April 2011. Surgeons excised 833 SLNs between the cohorts. Mean follow-up was 28.8 months.

SPECT/CT resulted in a greater frequency of SLNE in the head and neck than the standard method (23.5% vs. 2%; 95% CI, 14.1%-28.2%). There were 2.40 SLNs per patient in the SPECT/CT cohort and 1.87 SLNs per patient in the standard cohort (95% CI, 0.28-0.79). The SPECT/CT cohort also had a significantly greater number of positive SLNs per patient compared with the standard cohort (0.34 vs. 0.21; 95% CI, 0.21-0.31).

Four-year disease-free survival rate was calculated to be higher among the SPECT/CT cohort (93.9% vs. 79.2%; P=.02) because of a lower relapse rate (6.8% vs. 23.8%, P=.03).

“The preoperative visualization of SLN with SPECT/CT is technically feasible and facilitates the detection of additional positive SLNs,” the researchers concluded. “The use of this technique offers the physician the preoperative possibility of determining the exact location and visualization of the SLN.”

Disclosure: Dirk Schadendorf, MD, reported receiving consultancy fees, having board membership and receiving lecture fees from GlaxoSmithKline, Novartis, Amgen, Bristol-Myers Squibb, Roche, Genentech and MSD.