Radio-guided surgery: advantages of a new portable γ-camera (Sentinella) for intraoperative real time imaging and detection of sentinel lymph nodes in cutaneous malignancies.

BACKGROUND: The histological status of the sentinel lymph node (SLN) is one of the most relevant prognostic factors for the overall survival of patients with cutaneous malignancies, independent of tumour depth of the primary tumour.

OBJECTIVES: Our study seeks to evaluate the reliability and medical benefit of SLN excision (SLNE) performed with a portable γ-camera for intraoperative real time imaging of SLN.

METHODS: Therefore our study compares the visualization of SLN performed with preoperative lymphoscintigraphy and preoperative SPECT/CT with the intraoperative real time imaging of SLN performed with a new portable γ-camera (Sentinella) in 60 patients who were treated with a SLNE for early stage melanoma (n = 38), high risk cutaneous squamous cell carcinoma (n = 16), Merkel cell carcinoma (n = 4), sebaceous gland carcinoma (n = 1), and sweat glands carcinoma or porocarcinoma (n = 1).

RESULTS: Sixty patients were enrolled in this study. The portable γ-camera visualized all 126 preoperatively identified SLN. 23 additional SLN (15.4%) in 15 patients were only identified using the portable γ-camera. Two of these additional SLN showed metastatic involvement.

CONCLUSION: The portable γ-camera is an innovative imaging technique, reliable and providing additional information in the detection of SLN. Therefore SLNE with intraoperative γ-camera use is an attractive option to improve the detection of SLN in cutaneous malignancies and could help to reduce false negative SLN results.