Dynamic lymphoscintigraphy and image fusion of SPECT and pelvic CT-scans allow mapping of aberrant pelvic sentinel lymph nodes in XXXX .

@entity1 @entity5 @entity4298 @entity3 @entity320
To date, there are no reliable criteria to identify those @entity1 with @entity320 -infiltrated sentinel lymph nodes (SLNs) of the groin who might benefit from an extended lymphadenectomy, including the pelvic lymph nodes. We hypothesised that there are pelvic lymph nodes that receive lymph directly from the primary @entity5 , thus being at an increased risk for @entity3 . In order to determine the frequency of radioactively labelled pelvic lymph nodes and the kinetics of their appearance, we introduce here a combination of dynamic lymphoscintigraphy, single photon emission computed tomography (SPECT) and image fusion of SPECT and pelvic Computed Tomography (CT)-scans. By dynamic lymphoscintigraphy and intraoperative gamma probe detection, superficially located inguinal SLNs (median 2 nodes) could be identified in all of the 51 @entity1 included in this analysis. The histological search for micrometastases was positive in 16 @entity1 (median Breslow thickness of the primary @entity320 2.5 mm). In 29 @entity1 , SPECT and the image fusion technique were additionally performed. Radioactively labelled pelvic lymph nodes were detected in 20 individuals, 6 of them presenting aberrant pelvic SLNs that, on dynamic lymphoscintigraphy, had appeared simultaneously with the superficial @entity4298 (s). Of the 6 @entity1 in whom radioactive pelvic lymph nodes were excised together with the superficial @entity4298 (s), only one had positive superficial SLNs. In this @entity1 , the aberrant pelvic @entity4298 proved to be @entity5 -positive. In 9 @entity1 , there was no radiotracer uptake in the pelvic lymph nodes at all. Image fusion of SPECT and pelvic CT-scans is an excellent tool to localise exactly the @entity5 -draining nodes. The significance of radioactively labelled pelvic lymph nodes for the probability of pelvic metastases should be analysed further.
