Advantages of preoperative hybrid SPECT/CT in detection of sentinel lymph nodes in cutaneous head and neck malignancies.

ABSTRACT

BACKGROUND: There is some controversy around the value of sentinel lymph node excision (SLNE). Especially SLNE of cutaneous head and neck malignancies has been debated intensively, in part because of the complexity of the lymphatic drainage in this region associated with potential high morbidity. In order to improve preoperative three-dimensional mapping of sentinel lymph nodes (SLN), in the head and neck region, by means of hybrid single photon emission computed tomography/computed tomography (SPECT/CT) is gaining significance. Our study seeks to identify the potential medical and economic advantages of preoperative SPECT/CT in direct comparison to standard SLNE without SPECT/CT in patients with cutaneous head and neck malignancies. METHODS: We retrospectively analysed the data of 48 clinically lymph node-negative patients with early stage melanoma, high risk cutaneous squamous cell carcinoma and porocarcinoma, who underwent SLNE with or without preoperative SPECT/CT within 4 years. RESULTS: The SLNE in the head and neck region with SPECT/CT-technique demonstrated better postoperative aesthetic results had lower morbidity and significantly reduced operating time. Moreover, SLNE with SPECT/CT-technique in the head and neck region was feasible using local anaesthesia (LA) and significantly reduced resulting costs (€32.65/SLNE with LA vs. €334.57/SLNE with general anaesthesia, P < 0.0001). CONCLUSION: SPECT/CT is an innovative imaging technique, reliably and readily providing additional anatomical/functional information to detect and to excise SLN in the head and neck region. Therefore, SLNE with SPECT/CT-technique is an attractive option to improve the detection of SLN in cutaneous head and neck malignancies.