Title:Sentinel Node Identification in Melanoma: Current Clinical Impact, New Emerging SPECT Radiotracers and Technological Advancements. An Update of the Last Decade
VOLUME: 13 ISSUE: 1
Author(s):Natale Quartuccio*, Massimiliano Siracusa, Marco Pappalardo, Annachiara Arnone and Gaspare Arnone
Affiliation:Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo
Keywords:Melanoma, sentinel lymph node biopsy, 99mTc-Tilmanocept, 99mTc-colloids, SPECT/CT, hybrid imaging.
Abstract:
Background: Melanoma is the most lethal skin cancer with a mortality rate of 262 cases per
100.000 cases. The sentinel lymph node (SLN) is the first lymph node draining the tumor. SLN biopsy
is a widely accepted procedure in the clinical setting since it provides important prognostic information,
which helps patient management, and avoids the side effects of complete lymph node dissection.
The rationale of identifying and removing the SLN relies on the low probability of subsequent metastatic
nodes in case of a negative histological exam performed in the SLN.
Discussion: Recently, new analytical approaches, based on the evaluation of scintigraphic images are
also exploring the possibility to predict the metastatic involvement of the SLN. 99mTc-labeled colloids
are still the most commonly used radiotracers but new promising radiotracers, such as 99mTc-
Tilmanocept, are now on the market. In the last decades, single photon emission computed tomography-
computerized tomography (SPECT/CT) has gained wider diffusion in clinical departments and
there is large evidence about its superior diagnostic accuracy over planar lymphoscintigraphy (PL) in
the detection of SLN in patients with melanoma. Scientists are also investigating new hybrid techniques
combining functional and anatomical images for the depiction of SLN but further evidence
about their value is needed.
Conclusion: This review examined the predictive and prognostic factors of lymphoscintigraphy for
metastatic involvement of SLN, the currently available and emerging radiotracers and the evidence of
the additional value of SPECT/CT over PL for the identification of SLN in patients with melanoma.
Finally, the review discussed the most recent technical advances in the field.