Immediate dynamic lymphoscintigraphy delivers no additional value to lymphoscintigraphy 3 hr after tracer injection in sentinel lymph node biopsy in breast cancer patients

Abstract

The only impact of immediate lymphoscintigraphy was the possible omission of removal of 1-2 sec-echelon nodes per patient in 5% of patients. We consider this yield too low to continue immediate lymphoscintigraphy in breast cancer patients.

Repeat injection following sentinel node nonvisualization on lymphoscintigraphy images can decrease axillary dissection rate in breast cancer patients

“…For example, in the study by Doting et al . [18], the interval between reinjection and second lymphoscintigraphy was 3 h. Actually, it is not possible to confirm that sentinel node visualization after reinjection is due to reinjection or due to delayed visualization after the first injection.…”

“…One of the shortcomings of the previous studies on radiotracer reinjection in case of sentinel node nonvisualization is a long time between reinjection and second lymphoscintigraphy images. For example, in the study by Doting et al [18], the interval between reinjection and second lymphoscintigraphy was 3 h. Actually, it is not possible to confirm that sentinel node visualization after reinjection is due to reinjection or due to delayed visualization after the first injection.…”

“…Reinjection after nonvisualization on SPECT/ CT resulted in an additional 62.1% (36/58) visualization rate on subsequent planar imaging. Doting et al [18] Radiotracer reinjection in case of no focal accumulation of radioactive tracer in the lymph node basin(s) was seen, and imaging was repeated 3 h after this second injection. Axillary sentinel node was visualized in 17 (11%) of patients after reinjection.…”

“…A method to decrease the lymphatic mapping success rate in breast cancer patients is reinjection of the radiotracer in case of sentinel node mapping nonvisualization on lymphoscintigraphy [17][18][19][20][21][22]. However, reinjection of the radiotracer has not been evaluated enough in the literature.…”

Evaluation of a streamlined sentinel lymph-node imaging protocol in early-stage oral cancer

“…This finding is in accordance with the revised guidelines of the EANM, stating that early dynamic LSG should encompass the first 10–15 min post-injection [ 9 ]. In early-stage breast cancer, dynamic LSG was completely omitted from the SLN imaging protocol, without interfering with its diagnostic accuracy, as immediate dynamic LSG had no additional value in identifying SLNs [ 18 – 21 ]. In early-stage OSCC, however, dynamic LSG immediately post-injection is deemed essential, as it allows visualization of lymphatic vessels draining the injection site; assisting the discrimination between SLNs and higher echelon nodes (HEN) in the complex anatomy of the neck with its abundant lymph nodes [ 8 ].…”