Intraoperative Imaging Guidance for Sentinel Node Biopsy in Melanoma Using a Mobile Gamma Camera

Journal Article · Fri Apr 01 04:00:00 EDT 2011 · Annals of Surgery

DOI:https://doi.org/10.1097/SLA.0b013e3181f9b709· OSTI ID:1035512

Dengel, Lynn T; Judy, Patricia G; Petroni, Gina R; Smolkin, Mark E; Rehm, Patrice K; Majewski, Stan; Williams, Mark B; Slingluff Jr., Craig L

The objective is to evaluate the sensitivity and clinical utility of intraoperative mobile gamma camera (MGC) imaging in sentinel lymph node biopsy (SLNB) in melanoma. The false-negative rate for SLNB for melanoma is approximately 17%, for which failure to identify the sentinel lymph node (SLN) is a major cause. Intraoperative imaging may aid in detection of SLN near the primary site, in ambiguous locations, and after excision of each SLN. The present pilot study reports outcomes with a prototype MGC designed for rapid intraoperative image acquisition. We hypothesized that intraoperative use of the MGC would be feasible and that sensitivity would be at least 90%. From April to September 2008, 20 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and SLNB was performed with use of a conventional fixed gamma camera (FGC), and gamma probe followed by intraoperative MGC imaging. Sensitivity was calculated for each detection method. Intraoperative logistical challenges were scored. Cases in which MGC provided clinical benefit were recorded. Sensitivity for detecting SLN basins was 97% for the FGC and 90% for the MGC. A total of 46 SLN were identified: 32 (70%) were identified as distinct hot spots by preoperative FGC imaging, 31 (67%) by preoperative MGC imaging, and 43 (93%) by MGC imaging pre- or intraoperatively. The gamma probe identified 44 (96%) independent of MGC imaging. The MGC provided defined clinical benefit as an addition to standard practice in 5 (25%) of 20 patients. Mean score for MGC logistic feasibility was 2 on a scale of 1-9 (1 = best). Intraoperative MGC imaging provides additional information when standard techniques fail or are ambiguous. Sensitivity is 90% and can be increased. This pilot study has identified ways to improve the usefulness of an MGC for intraoperative imaging, which holds promise for reducing false negatives of SLNB for melanoma.

• Research Organization: Thomas Jefferson National Accelerator Facility, Newport News, VA (United States)
• Sponsoring Organization: USDOE Office of Science (SC)
• DOE Contract Number: AC05-06OR23177
• OSTI ID: 1035512
• Report Number(s): JLAB-PHY-11-1486; DOE/OR/23177-2024; National Institutes of Health Cardiovascular Surgery Research Training grant (T32 HL007849)
• Journal Information: Annals of Surgery, Journal Name: Annals of Surgery Journal Issue: 4 Vol. 253; ISSN 0003-4932; ISSN ANSUA5
• Country of Publication: United States
• Language: English

Related Subjects

59 BASIC BIOLOGICAL SCIENCES
60 APPLIED LIFE SCIENCES
BIOPSY
COLLOIDS
DETECTION
GAMMA CAMERAS
HOT SPOTS
LYMPH NODES
MELANOMAS
PATIENTS
PROBES
SENSITIVITY
SULFUR