Sentinel lymph node biopsy in endometrial and cervical cancers using freehand SPECT—first experiences

Markus, Alexander; Ray, Alessandra Sophia Carmen; Bolla, Daniele; Müller, Joachim; Diener, Pierre-André; Wendler, Thomas; Hornung, René

doi:10.1007/s10397-016-0969-x

Table 1 Table summarizes advantages and disadvantages of various techniques for SLN detection in patients with endometrial cancers

From: Sentinel lymph node biopsy in endometrial and cervical cancers using freehand SPECT—first experiences

Route of tracer application/technique of SLN detection	Advantage	Disadvantage	References (exemplary)
Route of tracer application
Ultrasound-guided intramyometrial injection	No anesthesia required	Painful procedure	[10]
Ultrasound-guided intramyometrial injection	Application the day prior to surgery with preoperative SPECT-CT	Technically challenging	[10]
Open or laparoscopic subserosal injection	Technically easy	Extends anesthesia and surgery time	[11]
	Under general anesthesia	No preoperative SPECT available
	Tracer application and main surgery during one single procedure	Unknown lymphatic drainage (serosa vs. endometrium)
		Low SLN detection rate
Intracervical	Easily applicable	Paraaortic SLN detection rate in endometrial cancers less frequent	[13–15]
	SPECT possible the before surgery
	No anesthesia required
Subendometrial injection	Mimics “natural” lymphatic drainage of endometrial cancer	Requires hysteroscopy	[17, 18]
		Requires general anesthesia
		Preoperative SPECT not possible
Technique of SLN detection
Isosulfan blue	Various ways of application of tracer possible	Wide opening Of retroperitoneal space required	[12, 19, 20]
	Stains lymph nodes and lymphatic vessels facilitating SLN detection	SLN detection may be cumbersome in obese patients
		A lot of tissue stains blue
Indocyanine green	Tissue stains only in fluorescence detection mode	Requires special equipment and light switch	[18, 19, 21–23]
	Easy detection of SLN	Wide opening of retroperitoneal space needed
	Various ways of application of tracer possible	SLN detection may be cumbersome in obese patients
Radioactive tracer with regular gamma probe for SLN detection	allows quick scanning of lymphatic basin	shadowing of SLN by radiation of injection site	[3, 24, 25]
	Various ways of application of tracer possible	Requires radiopharmacon and cooperation with department of nuclear medicine with according safety regulations
	Very small retroperitoneal opening needed	No SPECT
	Detection in obese patients possible
Freehand SPECT	Provides real-time 3D detection of SLN	Special instrumentation required	LAPSENT study
	Assists SLN localization	Requires radiopharmacon and cooperation with department of nuclear medicine with according safety regulations
	Application of tracer and SPECT and surgery in a single procedure
	Very small incision of the peritoneum needed

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