The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of Radiopharmaceutical Chemistry and Biology
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Q J Nucl Med Mol Imaging · Jun 2014
ReviewContribution of SPECT/CT imaging to radioguided sentinel lymph node biopsy in breast cancer, melanoma, and other solid cancers: from "open and see" to "see and open".
A few years ago SPECT/CT was successfully incorporated into the sentinel node (SN) procedure for breast cancer and melanoma. Important contributions of SPECT/CT in these two malignancies were the anatomical localization of SNs already visualized on planar images, the detection of additional SNs in aberrant basins, and the depiction of SNs in cases with no visualization on planar images. Recently, in a large series of melanoma patients the use of SPECT/CT was associated with the detection of more metastatic SNs and a higher rate of disease-free survival. ⋯ This recent imaging improvement is leading to a new paradigm of "see and open" in contraposition to the former "open and see" in the SN procedure. The new mixed reality protocols which are able to transfer SPECT/CT to the operating room for surgical navigation will reinforce this "see and open" concept. However, a comprehensive interpretation of SPECT/CT together with lymphoscintigraphy is necessary to identify radioactive lymph nodes as sentinel nodes and classify them into different categories that are important for the intraoperative procedure.
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Q J Nucl Med Mol Imaging · Jun 2014
ReviewA critical reappraisal of false negative sentinel lymph node biopsy in melanoma.
Lymphatic mapping and sentinel lymph node biopsy (SLNB) have completely changed the clinical management of cutaneous melanoma. This procedure has been accepted worldwide as a recognized method for nodal staging. SLNB is able to accurately determine nodal basin status, providing the most useful prognostic information. ⋯ Older age at diagnosis, deeper lesions, histologic ulceration, head-neck anatomical location of primary lesions are the clinical factors associated with false-negative SLNBs in melanoma patients. There is still much controversy about the clinical significance of a false-negative SLNB on the prognosis of melanoma patients. Indeed, most studies have failed to show that there is worse melanoma-specific survival for false-negative compared to true-positive SLNB patients.
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Q J Nucl Med Mol Imaging · Jun 2014
ReviewSentinel lymph node mapping in breast cancer: a critical reappraisal of the internal mammary chain issue.
Although, like the axilla, the internal mammary nodes (IMNs) are a first-echelon nodal drainage site in breast cancer, the importance of their treatment has long been debated. Seminal randomized trials have failed to demonstrate a survival benefit from surgical IMN dissection, and several retrospective studies have shown that IMNs are rarely the first site of recurrence. However, the recent widespread adoption of sentinel lymph node (SLN) biopsy has stimulated a critical reappraisal of such early results. ⋯ The fused SPECT/CT images represent a further technical solution to increase the identification of IMNs and consequently can significantly reduce the false negative rate of sentinel lymph node biopsy. Before mature results from current and future randomized trials assessing the benefit of IMN irradiation become available, lymphoscintigraphy and IMNs biopsy may be used to guide decisions regarding systemic and local-regional treatment. However, even in patients with visualized primary IMN drainage, the potential benefit of treatment should be balanced against the risk of added morbidity.
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Q J Nucl Med Mol Imaging · Mar 2014
ReviewDiagnostic flowcharts in osteomyelitis, spondylodiscitis and prosthetic joint infection.
Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. ⋯ The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.
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Tumour hypoxia results in biological alterations that leads to a more aggressive disease phenotype and is associated with resistance to treatment. In this review, we discuss current magnetic resonance imaging techniques, which can be applied to evaluate tumour hypoxia, highlighting the principles of each technique, their pre-clinical and clinical deployment, as well as their strengths and limitations. The potential to combine these techniques, and also with other imaging modalities (e.g., PET imaging) using a multiparametric approach, may further improve our understanding of the complex interaction of vascular supply, oxygen diffusion and tissue metabolism in pathogenesis of tumour hypoxia; and its reversal with treatment.