Premium
The predictive value of single‐photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy
Author(s) -
Remenschneider Aaron K.,
Dilger Amanda E.,
Wang Yingbing,
Palmer Edwin L.,
Scott James A.,
Emerick Kevin S.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25024
Subject(s) - medicine , sentinel lymph node , malignancy , radiology , lymph node , biopsy , single photon emission computed tomography , emission computed tomography , nuclear medicine , gamma probe , lymph , predictive value of tests , positron emission tomography , pathology , cancer , breast cancer
Objectives/Hypothesis Preoperative localization of sentinel lymph nodes in head and neck cutaneous malignancies can be aided by single‐photon emission computed tomography/computed tomography (SPECT/CT); however, its true predictive value for identifying lymph nodes intraoperatively remains unquantified. This study aims to understand the sensitivity, specificity, and positive and negative predictive values of SPECT/CT in sentinel lymph node biopsy for cutaneous malignancies of the head and neck. Study Design Blinded retrospective imaging review with comparison to intraoperative gamma probe confirmed sentinel lymph nodes. Methods A consecutive series of patients with a head and neck cutaneous malignancy underwent preoperative SPECT/CT followed by sentinel lymph node biopsy with a gamma probe. Two nuclear medicine physicians, blinded to clinical data, independently reviewed each SPECT/CT. Activity within radiographically defined nodal basins was recorded and compared to intraoperative gamma probe findings. Sensitivity, specificity, and negative and positive predictive values were calculated with subgroup stratification by primary tumor site. Results Ninety‐two imaging reads were performed on 47 patients with cutaneous malignancy who underwent SPECT/CT followed by sentinel lymph node biopsy. Overall sensitivity was 73%, specificity 92%, positive predictive value 54%, and negative predictive value 96%. The predictive ability of SPECT/CT to identify the basin or an adjacent basin containing the single hottest node was 92%. SPECT/CT overestimated uptake by an average of one nodal basin. In the head and neck, SPECT/CT has higher reliability for primary lesions of the eyelid, scalp, and cheek. Conclusions SPECT/CT has high sensitivity, specificity, and negative predictive value, but may overestimate relevant nodal basins in sentinel lymph node biopsy. Level of Evidence 4 Laryngoscope , 125:877–882, 2015