Chair for Computer Aided Medical Procedures & Augmented Reality
Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality

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C. Bluemel, A. Schnelzer, A. Rieger, A. Ehlerding, A. Okur, C. Gerngross, M. E. Martignoni, K. Scheidhauer, M. Schwaiger
3D navigated (radio-guided) sentinel lymph node biopsy using freehand SPECT : final evaluation of Munich's pilot experience in the operating room
50. Jahrestagung der Deutschen Gesellschaft für Nuklearmedizin, Messe Bremen, Germany, April 2012 (bib)

Evaluation of performance of sentinel lymph node (SLN) biopsy in breast cancer and melanoma patients (pts) using freehand (fh) SPECT.
Up to date, 64 patients (30-84 y) undergoing SLN biopsy were recruited (44 breast cancer pts (1 bilateral case), 20 melanoma pts) and scanned intraoperatively using fhSPECT (declipseSPECT, SurgicEye?, Munich, Germany). The amount of SLNs detected with fhSPECT before incision was counted and compared with the planar scintigraphy (PS) acquired the day before. After post-excision control of axillary region using gamma probe (GP), fhSPECT images were used to verify absence of radioactivity. Left hot spots were confirmed with GP. If clinically indicated, additional SLNs were resected.
Preoperatively, 104 SLNs were mapped on conventional PS (92 MBq, 48-127 MBq). Pre-incision GP managed to map SLNs in 61 of 65 cases (sensitivity 94%), and fhSPECT had a sensitivity of 95% (62/65). Compared to PS, fhSPECT mapped 88% of SLNs (91/104) in the identical position, as well as 3 further nodes. In total 163 SLNs were resected and confirmed to be radioactive, whereof metastatic involvement was found in 9 patients (pts). Post-excision fhSPECT detected in 21 pts (33%) left activity despite negative measurement with GP. In 8 pts (13%) 8 additional SLNs were resected.However, the additionally resected nodes were not separately sent to histopathological evaluation, so no potential change in the pathological nodal status could be determined. In the remaining 13 pts harvesting of these nodes was discarded as SLNs with higher uptake had been removed already. Pre-incision scans took approx. 2.3 min and post-excision scans 2.1 min; thus the mean surgical procedure was extended about 5 min.
Preliminary experience indicates that intraoperative imaging with fhSPECT for lymphatic mapping enables more intuitive and sensitive detection of SLNs than the use of conventional GP alone with minimal alteration of the surgical workflow. Post-excision fhSPECT showed remaining activity and motivated additional SLN dissection in 8 patients. Despite these data, no change in therapy could be observed. But the high number of residual SLNs motivates to setup a further prospective study to clarify the impact of fhSPECT on pathological status, therapy or prognosis. Furthermore, for quality assurance, the system can document the absence of residual SLNs at the end of surgery.
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