Paraaortic Sentinel Lymph Nodes: Toward Optimal Detection and Intraoperative Localization Using SPECT/CT and Intraoperative Real-Time Imaging

Paraaortic sentinel node biopsy may be a challenging proce-dure because the sentinel nodes are located retroperitoneally in close proximity to vital structures. The purpose of this study was to describe and evaluate the value of preoperative SPECT/ CT for lymphatic mapping, and a portable g-camera for intra-operative radioguidance, in patients with paraaortic sentinel nodes. Methods: We evaluated our practice in 18 patients, who were treated at The Netherlands Cancer Institute with sen-tinel lymphadenectomy for different urologic malignancies and showed paraaortic drainage on preoperative images. After intratumoral injection of 99mTc-nanocolloid, the patients under-went sequential planar lymphoscintigraphy, hybrid SPECT/CT, and sentinel lymphadenectomy. Intraoperative node detection and localization were guided by a laparoscopic g-probe and a portable g-camera. This g-camera was set to display bot