Clinical Breast Lymphoscintigraphy: Optimal Techniques for Performing Studies, Image Atlas, and Analysis of Images

Abstract

Breast lymphoscintigraphy is increasingly performed before surgery to delineate the drainage to the sentinel node (SN) in the axilla. On the basis of the histologic status of harvested SNs, the disease status of the entire axilla can be predicted. This prediction allows a more limited dissection to be performed while maintaining staging accuracy comparable with that of classic axillary lymph node dissection. Lymphoscintigraphy assists surgeons in harvesting the SN during gamma probe-assisted axillary biopsy or dissection and provides a wide field of view survey, among other benefits. When certain injection protocols are used, lymphoscintigraphy can be performed in the afternoon before surgery the next morning, thus minimizing disruptions of tight surgical schedules. Image acquisition can be optimized and SN activity can be maximized by means of such factors as parameters for preparation of the radiotracer, injection techniques, energy settings for the gamma camera, breast displacement maneuvers, and techniques for marking and outlining the patient's body. The ultimate goals are to delineate the true SN, maximize activity in the node for facilitated removal (even at next-day surgery), and deliver the information to the surgeon without delaying the surgical schedule.

Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

“…[1][2][3][4][5][6][7][8][9][10] Koizumi et al 11 demonstrated enhancement of hot node detection by adding the anterior oblique 60° view to the anterior oblique 30° view for a tumor located at the upper lateral quadrant region. They suggested that multi-directional views contributed to depicting axillary nodes behind the injected radioactivity.…”

“…[1][2][3][4][5][6][7][8][9][10] Of many factors affecting the detection of SLN, patient positioning or choice of the best scintigraphic projection is one of the most important factors affecting satisfactory lymphoscintigraphic study. Sentinel node lymphoscintigraphy is usually obtained in a supine position, with the arm abducted completely to allow the head of the γ-camera to be placed as close as possible to the axilla.…”

Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

“…Delayed migration has the same finding specially in obese or old patients with reduced tracer migration from injection site to SLN (Krynyckyi et al, 2004;Goyal et al, 2006;Soran et al, 2007). This could be due to increased fatty tissue with impeding the flow of the tracer through the lymphatics or fatty degeneration of LNs reducing their capacity to concentrate the tracer.…”

“…Tissue attenuation and shine through effect of injection site are causes other than tumoral infiltration which lead to non-visualized SLN in lymphoscintigraphy but detected by intraoperative gamma probe (Krynyckyi et al, 2004). Delayed migration has the same finding specially in obese or old patients with reduced tracer migration from injection site to SLN (Krynyckyi et al, 2004;Goyal et al, 2006;Soran et al, 2007).…”

“…Slow or no migration to SLN may technically occur with large-sized radiocolloids and insufficient time between injection and scan/ surgery as well as in deep injection with inherent slow migration (Krynyckyi et al, 2004;Soran et al, 2007).…”