Contribution of SPECT/CT for sentinel node localization in patients with ipsilateral breast cancer relapse

Abstract

BackgroundIn recent years repeat sentinel node (SN) biopsy has been proven to be feasible in local breast cancer recurrence (LBCR). However, in these patients SNs outside the ipsilateral axilla are frequently observed. This study evaluates the contribution of SPECT/CT for SN localization and surgical adjustment in LBCR patients.MethodsSN biopsy was performed in 122 LBCR patients (median age 60.5 years, range 24–87), enrolled from August 2006 to July 2015. Median disease-free time lapse was 109.5 months (range 9–365). Axillary lymph node dissection (ALND) had previously been performed in 55 patients, SN biopsy in 44, both techniques in 13 and fine-needle aspiration in 10. Primary breast cancer treatment included radiotherapy in 104 patients (85.3 %) and chemotherapy in 40 (32.8 %). Preoperative lymphatic mapping, using planar scintigraphy (PS) and SPECT/CT included report of SN location according to lymph node territory. In case of a territorial PS-SPECT/CT mismatch, surgery was adjusted according to SPECT/CT findings.ResultsSPECT/CT SN visualization rate was higher than PS (53.3 % vs. 43.4 %, p n.s.) with, in total, 19 additional SN (118 vs. 99, p n.s.). PS-SPECT/CT territory mismatch, found in 60 % (39/65) of patients with SN visualization, led to surgical adjustment in 21.3 % (26/122) of patients. The SN procedure was finally performed in 104 patients resulting in a 65.7 % surgical retrieval rate with a total of 132 removed SNs (1.86/patient). SN metastases were found in 17/71 patients (23.9 %), in 16 of them (94 %) in ipsilateral basins outside the axilla or in the contralateral axilla.ConclusionUsing SPECT/CT there is a trend to visualize more SNs in LBCR, providing at the same time important anatomical information to adjust intraoperative SN procedures. The addition of SPECT/CT to the standard imaging protocol may lead to better staging mainly in patients presenting drainage outside the ipsilateral axilla.

Definition of Internal Mammary Node Target Volume Based on the Position of the Internal Mammary Sentinel Lymph Nodes Presented on SPECT/CT Fusion Images

“…The radiotracer of lymphoscintigraphy can enter lymphatic capillaries via the gaps between cell junctions and the intercellular clefts formed by overlapping cells, followed by the lymphatic drainage, and finally gathered in the SLNs to form as a "hot spot" on SPECT image. The SPECT/CT was able to provide functional and anatomical information simultaneously, and locate IM-SLN more accurately (23). Based on these, in our current study, we try to find out the relationship between IM-SLN and consensus guidelines.…”

Advanced diagnostic imaging of sentinel lymph node in early stage breast cancer

“…13 SPECT/CT can detect SLN that cannot be detected by planar imaging, resulting in upstaging and therapy change in 9.6%-21.3% of patients. 13,14 SPECT/CT can provide accurate anatomical information about SLN and more appropriate therapies for patients (Figure 2). 12 However, its cost is relatively higher.…”

“…12,13 It is also useful for scanning invisible, unexplained, or unexpected SLNs (Figure 1). 13 SPECT/CT can detect SLN that cannot be detected by planar imaging, resulting in upstaging and therapy change in 9.6%-21.3% of patients. 13,14 SPECT/CT can provide accurate anatomical information about SLN and more appropriate therapies for patients (Figure 2).…”

“…The SLN recognition rates of 99m Tc‐Rituximab and 99m Tc‐sulfur colloid guided SPECT/CT in the axillary area were 100% and 98.4%, respectively, and 98.5% and 98.7 in all areas 10 . Compared with lymphangiography alone, SPECT/CT has obvious advantages in the detection of internal breast LNs 11 and ipsilateral axillary external drainage 12,13 . It is also useful for scanning invisible, unexplained, or unexpected SLNs (Figure 1).…”

European research trends in nuclear medicine

“…Borrelli et al [ 9 ] evaluated whether the use of single-photon emission computed tomography/computed tomography (SPECT/CT) improved both visualization and anatomical localization of SN, and whether this additional information would have had any impact on the surgical approach and consequent retrieval of SN in patients with local breast cancer relapse (LBCR). They reported that the addition of SPECT/CT to the standard planar imaging protocol for lymphatic mapping and SN localization in LBCR patients appeared to improve detection of SN and their anatomical localization, and it led to better staging mainly in patients presenting drainage outside the ipsilateral axilla.…”