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Clinical Investigation |
1 Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; 2 GE Healthcare, Haifa, Israel; 3 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and 4 Department of Radio-Isotope Guided Surgery Unit of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
Correspondence: For correspondence or reprints contact: Hedva Lerman, MD, Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, 64239 Israel. E-mail: hedval{at}tasmc.health.gov.il
Overweight has been reported as a cause for the nonvisualization of sentinel nodes (SNs) on preoperative planar lymphoscintigraphy in patients with breast cancer. The purpose of this study was to assess whether SPECT/CT may improve SN identification in overweight patients. Methods: Lymphoscintigraphy was performed in 220 consecutive patients with breast cancer. Body mass index (BMI) was calculated for each. A total of 122 patients were overweight or obese (BMI, 
25). Planar images and SPECT/CT images were interpreted separately, and SN identification on each of the modalities was related to BMI and to findings at surgery. Results: Planar imaging identified SNs in 171 patients (78%) with a BMI (mean ± SD) of 25.2 ± 4 kg/m2 and failed to do so in 49 patients (22%) with a BMI of 28 ± 8 kg/m2. In 29 of the latter patients (59%), SNs were identified on SPECT/CT. SPECT/CT detected "hot" nodes in 200 patients (91%) and failed to do so in 20 patients with a BMI of 29.2 ± 6.6 kg/m2. For the 122 overweight or obese patients, planar assessment failed to identify SNs in 34 patients (28%) and SPECT/CT failed to do so in 13 patients (11%) (P < 0.001). For 116 patients, surgery took place in our hospital (Tel-Aviv Sourasky Medical Center). An intraoperative blue dye technique failed to detect SNs in 48 patients (41%) with a BMI of 28.2 ± 7 kg/m2. SPECT/CT localized hot nodes in 36 (75%) of the latter patients, and planar imaging did so in 22 (46%) of those patients. Of 19 patients for whom scintigraphy failed, 6 (32%) had nodal metastatic involvement. Conclusion: The addition of SPECT/CT to lymphoscintigraphy improved SN identification in overweight patients with breast cancer. Moreover, SPECT/CT accurately identified SNs in 75% of patients for whom the identification of SNs by the intraoperative blue dye technique failed.
Key Words: lymphoscintigraphy • sentinel node • SPECT/CT • breast • cancer
COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.
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