Numerical Analysis of Sentinel Lymph Node Detection Using Technetium-99m: A Step Toward Objective Scintigraphy Evaluation in Oncology

• Autorzy: Szatkowski Wiktor , Popieluch Joanna , Blecharz Paweł , Kisielewicz Kamil

Identyfikatory

DOI

10.5604/01.3001.0055.1198

• Języki publikacji: EN

Abstrakty

EN

Objective: Scintigraphy with technetium-99m (Tc-99m) is essential for sentinel lymph node (SLN) detection in gynecological cancers, aiding preoperative planning and reducing unnecessary lymphadenectomy. However, traditional image interpretation is subjective. This study applies numerical tools: signal-to-noise ratio (SNR) and C factor (SLN SNR/ background SNR) to objectively assess scintigraphic image quality and protocol efficacy. Materials and methods: A total of 172 patients with endometrial cancer underwent SLN detection at the Maria Sklodowska-Curie National Research Institute of Oncology, Kraków branch (from 2016–2024). Two protocols were compared: 1. short protocol: 40 MBq Tc-99m, planar imaging - 30 minutes post-injection; 2. long protocol: 120 MBq Tc-99m, planar imaging - 18 hours post-injection. SLN detection was confirmed intraoperatively using a gamma probe and subsequently verified by histopathology. Results: The long protocol achieved a detection sensitivity of 94%, compared to 70% in the short protocol. Based on the analysis, the minimum SNR required for effective SLN detection was 1.46, and the threshold C factor was ≥ 3.61. Although the mean SNR in the long protocol was lower (3.51), the prolonged biological retention of Tc-99m in SLNs contributed to improved detection accuracy. Conclusions: Numerical analysis of SLN scintigraphy in 172 patients provides an objective framework for evaluating image quality and improves detection accuracy. The long protocol offers superior visualization of sentinel lymph nodes. Standardized quantitative imaging may support the development of automated and AI-assisted diagnostic tools in nuclear medicine.

Słowa kluczowe

EN

technetium-99m; sentinel lymph node detection; lymphoscintigraphy; quantitative imaging; gynecological cancer; diagnostic accuracy; scintigraphy protocols; SPECT/CT

• Wydawca: Uniwersytet Jagielloński - Collegium Medicum ; Index Copernicus Sp. z o.o.
• Czasopismo: Bio-Algorithms and Med-Systems
• Rocznik: 2025
• Tom: Vol. 21, no 1
• Strony: 7--12
• Opis fizyczny: Bibliogr. 8 poz., rys., tab.

Twórcy

autor

Szatkowski Wiktor

• Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Division, Krakow, Poland

• https://orcid.org/0000-0001-7682-7176

autor

Popieluch Joanna

• Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Division, Krakow, Poland

autor

Blecharz Paweł

• Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Division, Krakow, Poland

• https://orcid.org/0000-0001-5310-0054

autor

Kisielewicz Kamil

• Department of Medical Physics, Maria Sklodowska- -Curie National Research Institute of Oncology, Krakow Division; Garncarska street 11, 31-115 Krakow, Poland

• https://orcid.org/0000-0003-3217-2918

Bibliografia

• 1. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16(2):170-99.
• 2. Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12-39. doi: https://doi.org/10.1136/ijgc-2020-002230.
• 3. Szatkowski W, Pniewska K, Janeczek M, Ryś J, Banaś T, Muzykiewicz K, et al. The assessment of sentinel lymph node mapping methods in endometrial cancer. J. Clin. Med. 2025;14(3):676. doi: https://doi.org/10.3390/jcm14030676.
• 4. Smith B, Backes F. The role of sentinel lymph nodes in endometrial and cervical cancer. J. Surg. Oncol. 2015;112:753-60.
• 5. Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K, et al. SPECT/CT. J Nucl Med. 2008;49:1305-19.
• 6. Yusuf EE. Limits of tumor detectability in nuclear medicine and PET. Mol Imaging Radionucl Ther. 2012;21(1):14-20. doi: https://doi.org/10.4274/Mirt.37239.
• 7. Frati A, Ballester M, Dubernard G, Bats AS, Heitz D, Mathevet P, et al. Contribution of lymphoscintigraphy for sentinel lymph node biopsy in women with early-stage endometrial cancer: Results of the SENTI-ENDO study. Ann Surg Oncol. 2015;22(6):1980-6. doi: https://doi.org/10.1245/ s10434-014-4286-7.
• 8. Bats AS, Lavoué V, Rouzier R, Coutant C, Kerrou K, Darai E. Limits of day-before lymphoscintigraphy to localize sentinel nodes in women with cervical cancer. Ann Surg Oncol. 2008;15(9):2173-9. doi: https://doi.org/10.1245/s10434-008-9896-6.