Detection of Sentinel Lymph Node in Endometrial Cancer Using ^99mTc-Nanocolloid SPECT/CT: A Retrospective Cohort Study

Abstract

Background Sentinel lymph node mapping (SLNM) using ^99mTc-nanocolloid single photon emission tomography/computed tomography (SPECT/CT) is a minimally invasive technique for detecting lymphatic metastasis in early-stage endometrial cancer. This study aimed to evaluate the detection rate (DR) of sentinel lymph nodes (SLNs) using SPECT/CT and compare the findings with intraoperative gamma probe evaluation and histopathological results.

Methods A retrospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between December 2022 and January 2024. Twenty-six patients with FIGO (International Federation of Gynecology and Obstetrics) stage I endometrial cancer were included. ^99mTc-nanocolloid was injected into four cervical quadrants, followed by SPECT/CT imaging and intraoperative gamma probe evaluation. Histopathological analysis was performed to confirm the presence of metastasis.

Results SLNs were detected in 20 patients (76.9%) using SPECT/CT, with 100% concordance with gamma probe findings. Histopathological analysis identified metastasis in four patients (15.4%). Tumor size was significantly associated with SLN detection (p < 0.001), with larger tumors (> 4 cm) more frequently associated with positive SLNs. However, no significant correlation was found between SPECT/CT maximum counts and histopathological metastasis (p: 0.156). Among the six patients with negative SPECT/CT findings, all patients underwent lymphadenectomy, and no metastasis was detected in these cases.

Conclusion SPECT/CT using ^99mTc-nanocolloid is an effective tool for SLNM in early-stage endometrial cancer, demonstrating a high DR and perfect concordance with intraoperative gamma probe findings. Its superior anatomical accuracy enhances surgical planning. Tumor size significantly influences SLN detection, with larger tumors being more frequently associated with positive SLNs. However, SPECT/CT count intensity does not correlate with histopathological metastasis.

Keywords

endometrial cancer - sentinel lymph node - 99mTc-nanocolloid - SPECT/CT - gamma probe - metastasis detection

Publikationsverlauf

Artikel online veröffentlicht:
12. März 2025

• References

• 1 Koskas M, Amant F, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet 2021; 155 (Suppl 1, Suppl 1): 45-60
• 2 Oaknin A, Bosse TJ, Creutzberg CL. et al; ESMO Guidelines Committee. Electronic address: [e-mail]. Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33 (09) 860-877
• 3 Sumita M, Bindiya G. Recent Advances in Endometrial Cancer. Singapore: Springer Singapore; 2020
• 4 Volterrani D, Erba PA, Carrió I, Strauss HW, Mariani G. Nuclear Medicine Textbook: Methodology and Clinical Applications. Cham: Springer; 2019
• 5 Jankulovska A, Stoilovska Rizova B, Bozhinovska N. et al. Preoperative detection of sentinel lymph node in patients with endometrial cancer - comparison of planar lymphoscintigraphy, spect and SPECT/CT. Nucl Med Rev Cent East Eur 2022; 25 (02) 101-104
• 6 Sicignano M, Mansi L. G. Mariani, S. Vidal-Sicart, R.A. Valdes Olmos (Eds): Atlas of Lymphoscintigraphy and Sentinel Node Mapping, Second Edition. Eur J Nucl Med Mol Imaging 2021; 48 (11) 3345-3346
• 7 Collarino A, Vidal-Sicart S, Olmos RAV. Nuclear medicine manual on gynaecological cancers and other female malignancies. 2022 . 10.1007/978-3-031-05497-6
• 8 Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023; 73 (01) 17-48
• 9 Creasman WT, Odicino F, Maisonneuve P. et al. Carcinoma of the corpus uteri. Int J Gynaecol Obstet 2006; 95 (S1): S105-S143
• 10 Wu Y, Sun W, Liu H, Zhang D. Age at menopause and risk of developing endometrial cancer: a meta-analysis. BioMed Res Int 2019; 2019: 8584130
• 11 Azueta A, Gatius S, Matias-Guiu X. Endometrioid carcinoma of the endometrium: pathologic and molecular features. Semin Diagn Pathol 2010; 27 (04) 226-240
• 12 Bogani G, Ray-Coquard I, Concin N. et al. Endometrial carcinosarcoma. Int J Gynecol Cancer 2023; 33 (02) 147-174
• 13 Crusio WE, Lambris JD, Radeke HH. Hormonal Pathology of the Uterus. Vol. 1242. Cham: Springer; 2020
• 14 World Health Organization (WHO). Female Genital Tumours. 5th ed.. Vol. 4. Lyon: International Agency for Research on Cancer; 2020
• 15 Sohaib SA, Houghton SL, Meroni R, Rockall AG, Blake P, Reznek RH. Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clin Radiol 2007; 62 (01) 28-34 , discussion 35–36
• 16 Jin X, Shen C, Yang X, Yu Y, Wang J, Che X. Association of tumor size with myometrial invasion, lymphovascular space invasion, lymph node metastasis, and recurrence in endometrial cancer: a meta-analysis of 40 studies with 53,276 patients. Front Oncol 2022; 12: 881850
• 17 Zhai L, Zhang X, Cui M, Wang J. Sentinel lymph node mapping in endometrial cancer: a comprehensive review. Front Oncol 2021; 11: 701758
• 18 Zhu M, Jia N, Huang F. et al. Whether intermediate-risk stage 1A, grade 1/2, endometrioid endometrial cancer patients with lesions larger than 2 cm warrant lymph node dissection?. BMC Cancer 2017; 17 (01) 696
• 19 Schink JC, Rademaker AW, Miller DS, Lurain JR. Tumor size in endometrial cancer. Cancer 1991; 67 (11) 2791-2794
• 20 La Verde N, Biagioli E, Gerardi C. et al. Role of patient and tumor characteristics in sentinel lymph node metastasis in patients with luminal early breast cancer: an observational study. Springerplus 2016; 5 (01) 114
• 21 Min SK, Lee SK, Woo J. et al. Relation between tumor size and lymph node metastasis according to subtypes of breast cancer. J Breast Cancer 2021; 24 (01) 75-84
• 22 Abdelkawi MM, Sweed MS, Adel M, NasrElDin EA. Risk stratification of endometrial cancer and lymph node metastases prediction using 18F-FDG PET/CT: role of metabolic tumor volume and total lesion glycolysis. Egypt J Radiol Nucl Med 2022; 53 (01) 49