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Improved Body-Outline Imaging Technique for Localization of Sentinel Lymph Nodes in Breast Surgery

Department of Physics and Nuclear Medicine, City Hospital NHS Trust, Birmingham, United Kingdom

Many centers use techniques for localizing the sentinel lymph node (SLN) associated with a breast tumor. Protocols involve the use of an intraoperative probe and blue dye but may or may not include scintigraphy. Methods: Three methods of body-outline imaging were investigated to aid SLN localization. Body outlines were acquired using a handheld source; a transmission image was acquired from a ⁵⁷Co-flood source; and, finally, a new method is described using a ¹⁵³Gd-line source attenuation correction for body outline. Results: Method 1 images were of low quality, although 83% of SLNs were visualized. Body outline was unsatisfactory for surgical localization. Method 2 was unsatisfactory because of the lack of a lateral image. Method 3 enabled good presurgical visualization of the SLN (73%) and speeded surgical localization. Conclusion: The ¹⁵³Gd-line source consistently gives optimal-quality body-outline images. This source is simple, quick, and clearly locates the SLN on multiple projections.

Key Words: sentinel lymph node • breast tumor • lymph node imaging

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