Utility of single-photon emission tomography/computed tomography for sentinel lymph node localization in breast cancer patients

Giżewska, Agnieszka; Witkowska-Patena, Ewa; Osiecki, Sebastian; Mazurek, Andrzej; Stembrowicz-Nowakowska, Zofia; Dziuk, Mirosław

doi:10.1097/mnm.0000000000000676

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…Preoperative SLN localization would reduce the scope of surgical resection, important for breast-conserving surgery. In a previous study, radioisotope (Co-57) was often appropriately positioned on the side of the body opposite the camera for reference, exposing patients to extra radiation [ 23 ]. We innovatively made a simple and safe tool for localizing SLNs.…”

Section: Discussionmentioning

confidence: 99%

Value of Quantitative SPECT/CT Lymphoscintigraphy in Improving Sentinel Lymph Node Biopsy in Breast Cancer

Luan

et al. 2022

The Breast Journal

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Background and Objectives. Sentinel lymph node biopsy has been widely accepted as the standard procedure to assess the axillary lymph node status in breast cancer. However, more than 70% of excised sentinel lymph nodes have been found to be healthy. It may lead to unnecessary excisions and increase the incidence of postoperative complications. The aim of this study was to investigate the value of quantitative Tc-99 m sulfur colloid SPECT/CT in avoiding excessive removal of unnecessary sentinel lymph nodes in breast cancer patients. Methods. We retrospectively enrolled breast cancer patients who underwent SPECT/CT prior to sentinel lymph node biopsy. Quantification of radiotracer uptake from SPECT/CT data was performed. A radioactivity count threshold (RSPECT) using SPECT/CT was calculated for detecting metastatic sentinel lymph nodes. To localize sentinel lymph nodes exactly, we compared the positions of sentinel lymph nodes localized using SPECT/CT with positions localized surgically using an intraoperative γ-probe. Results. 491 patients were included, with a median of 3 sentinel lymph nodes/patient detected by the γ-probe and 2 sentinel lymph nodes/patient detected by SPECT/CT. As the number of sentinel lymph nodes visualized on SPECT/CT images, the metastasis incidence of lymph nodes in the ≤2 SLNs group was significantly higher than that in the >2 SLNs group (35% vs. 15%, P < 0.001 ). No metastasis was found in lymph nodes with RSPECT ≤ 30% in the >2 SLNs group, and thus, 30% (157/526) of SPECT/CT-identified nodes would avoid unnecessary removal. The positions of sentinel lymph nodes localized by SPECT/CT and γ-probe were identical in 42% (39/93) of patients. Conclusions. Quantitative Tc-99 m SC SPECT/CT imaging has the potential to preoperatively locate sentinel lymph nodes and intraoperatively avoid unnecessary sentinel lymph node biopsy.

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Section: Discussionmentioning

confidence: 99%

Value of Quantitative SPECT/CT Lymphoscintigraphy in Improving Sentinel Lymph Node Biopsy in Breast Cancer

Luan

et al. 2022

The Breast Journal

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“…Results of our study have further potential clinical application with conventional ARM techniques, with the addition of SPECT/CT lymphoscintigraphy enabling accurate localization of the SLN(s) and lymphatics draining the upper extremity (Figures 2‐5). The SPECT/CT can be merged with the radiation oncology simulation treatment planning CT to allow identification of the ARM SLN(s) draining the upper extremity 30 . This can then be mapped to be included, or spared, from the radiation field, with one study finding that the majority (72%) of ARM nodes were located outside of the tangential whole breast radiotherapy fields 31 .…”

Section: Discussionmentioning

confidence: 99%

Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer

Coroneos

Woodward

Wong

et al. 2020

Journal of Surgical Oncology

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Background This study characterizes the physiological drainage of the normal upper extremity using single‐photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy axillary reverse lymphatic mapping (ARM). Methods A consecutive series of patients assessed with SPECT/CT lymphoscintigraphy ARM of the upper extremity were included. Anatomical localization of the axillary sentinel lymph nodes (SLN) was completed in normal axillae in relation to consistent anatomic landmarks. Retrospective case note analysis was performed to collect patient demographic data. Results A total of 169 patients underwent SPECT/CT lymphoscintigraphy, and imaging of 182 normal axillae was obtained. All patients (100%) had an axillary SLN identified: 19% had a single contrast‐enhanced SLN in the axilla and the remainder had multiple. The SLN(s) of the upper extremity was located in the upper outer quadrant (UOQ) of the axilla in 97% of cases (177 axillae). When the SLN(s) was found in the UOQ of the axilla, second‐tier lymph nodes were found predominantly in the upper inner quadrant (50% of cases). Conclusions The upper extremity SLN(s) is located in a constant region of the axilla. This study provides the most complete investigation to date and results can be directly applied clinically to ARM techniques and adjuvant radiation planning.

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Key Topic: Multimodal Evaluation of the Lymphedema Patient

Schaverien

Dayan

2022

Multimodal Management of Upper and Lower Extremity Lymphedema

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Utility of single-photon emission tomography/computed tomography for sentinel lymph node localization in breast cancer patients

Cited by 7 publications

References 21 publications

Value of Quantitative SPECT/CT Lymphoscintigraphy in Improving Sentinel Lymph Node Biopsy in Breast Cancer

Value of Quantitative SPECT/CT Lymphoscintigraphy in Improving Sentinel Lymph Node Biopsy in Breast Cancer

Anatomy and physiology of the sentinel lymph nodes of the upper extremity: Implications for axillary reverse mapping in breast cancer

Key Topic: Multimodal Evaluation of the Lymphedema Patient

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