The Use of Sentinel Lymph Node in Breast, Melanoma, Head & Neck and Pelvic Cancers

Closed for proposals

Project Type

Coordinated Research Project

Project Code




Approved Date

2 September 2010

Start Date

12 October 2010

Expected End Date

31 December 2013

Completed Date

22 November 2013


Today, more than 50% of new cancer cases and nearly two thirds of cancer deaths occur in the low-income, lower middle-income and upper middle-income countries. By the year 2030, the developing world is expected to bear 70% of the global cancer burden. Locally advanced cancers are more prevalent developing countries, in part due to an insufficient screening programme. Sentinel Lymph Node Biopsy (SLNB) is an accepted standard-of-care in the management of breast cancer and  melanoma and is gaining acceptance in other solid malignancies e.g. head and neck, prostate and cancer of the cervix.  Although SLN detection was initially introduced for its usefulness for early cancer management, there is an incentive to study the usefulness of this procedure for improving the management of patients with locally advanced cancers and for the detection of SLN in areas of unpredictable drainage patterns. Emerging hybrid technologies show promise in improving the accuracy of detection and enhancing patient management. This CRP aims at studying the impact of the following on improving the accuracy of SLN detection; i) the introduction of SPECT/CT as an adjunct to conventional nuclear medicine imaging; ii)  the added value of using Intra-operative imaging devices; iii) investigating the performance of mannose receptor targeting radiopharmaceuticals developed in collaboration with division of Industrial Applications and  Chemistry Section.In addition, this coordinated research project will contribute to promoting a quality assurance and training programme for participating centres to ensure uniform and high-quality performance.


To improve the accuracy of SLN detection using novel and hybrid technologies tailored to the needs of the developing MS in cases of Breast Cancer, Cutaneous Malignant Melanoma, Head and Neck and Pelvic Malignancies.

Specific objectives

To assess the add-on value of axillary ultrasound and possibly PET/CT for stratification towards selective axillary lymph node dissection prior to submission to SLNM in locally advanced breast cancer.

To assess the potential use of two novel mannose receptor-based SLNM agents in humans (Co-op. with NAPC).

To investigate the add-on value of SPECT/CT over Planar imaging for the identification of sentinel nodes in cases of breast cancer, malignant melanoma, head and neck cancers and pelvic cancers.


The CRP found significantly more sentinel lymph node involvement with SPECT/CT, which altered surgical planning for many of our patients--a finding that was repeated across all malignancies and clinical institutions. These results could potentially inform new clinical practice and shape appropriate use of SPECT/CT imaging for patients selected for surgery. Changes in surgical planning as dictated by SPECT/CT were substantial and would impact clinical practice.

Study findings showed that SPECT/CT breast cancer imaging caught 13 percent more cancerous sentinel nodes--2,165 nodes versus 1,892 using planar lymphoscintigraphy. The hybrid SPECT system also caught 11.5 percent more sentinel nodes when imaging for melanoma, with 602 versus 532 nodes detected. In addition, 29.2 percent more nodes were imaged using SPECT/CT to detect pelvic cancer--195 nodes found versus 138 with planar imaging.

Changes in surgical planning as dictated by SPECT/CT were substantial--16.9 percent of breast cancer surgeries underwent a change in management, 37 percent of surgeries for melanoma changed and 64.1 percent of surgical plans for pelvic cancer were changed due to detection of additional sentinel nodes.


This comprehensive international study that demonstrates the superiority of SPECT/CT over planar lymphoscintigraphy for the detection of sentinel lymph node malignancy in a variety of cancers. It placed an emphasis on the role of nuclear techniques in human health, specifically, how nuclear technologies such as hybrid imaging would play an important role on the management of patients with cancer.

CRP Publications


Research journal


J Nuclear Med September 1, 2015 vol. 56 no. 9 1338-1344

Publication URL


We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumours. Methods: From 2010 to 2013, 1,508 patients were recruited in a multicentre study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1–3 h after injection of 99mTc-colloid particles. Surgery was performed the same or next day. Results: Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer. Conclusion: SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.


The Journal of Nuclear Medicine

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