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Factors Affecting Sentinel Node Localization During Preoperative Breast Lymphoscintigraphy

Joyce Eisenberg Keefer Breast Center and Division of Surgical Oncology, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica; Statistical Coordinating Unit, John Wayne Cancer Institute, and Department of Nuclear Medicine, Saint John's Health Center, Santa Monica, California

View larger version (15K): [in this window] [in a new window]   FIGURE 1. Frequency of AX, IM, and CL sentinel nodes found on preoperative lymphoscintigraphy in all cases. No correlation was found between inner versus outer quadrant primary tumors and location of sentinel node.

View larger version (38K): [in this window] [in a new window]   FIGURE 2. Lymphoscintigrams from patient with upper outer quadrant tumor in left breast 30 min after injection at primary tumor site. MOVA shows distinct AX sentinel nodes (A) that are not seen on anterior view (B). MOVA revealed AX sentinel nodes in all patients, whereas anterior view missed 50% of AX sentinel nodes.

View larger version (81K): [in this window] [in a new window]   FIGURE 3. (A) Patient positioned on foam wedge with arm extended and abducted overhead to obtain MOVA image. (B) Schematic representation of craniocaudal view of breast at time of lymphoscintigraphy for outer quadrant tumor. (Left) In anterior view, distance projected onto scintillation camera (y) from injection site to AX sentinel node (SN) is short. (Right) Using MOVA, patient positioning on 45° wedge allows breast and injection site to shift medially from AX sentinel node, increasing distance y, and brings sentinel node closer to gamma camera (x), thereby improving AX sentinel node identification.

View larger version (45K): [in this window] [in a new window]   FIGURE 4. Lymphoscintigrams from patient with upper outer quadrant tumor in left breast 15 min after injection at primary tumor site. MOVA reveals AX sentinel nodes (A), whereas anterior view shows distinct IM sentinel node, but AX sentinel nodes are not visualized (B). Both MOVA and anterior images must be obtained to evaluate all regional drainage sites.