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Improved Sentinel Node Identification by SPECT/CT in Overweight Patients with Breast Cancer

Hedva Lerman1, Gennady Lievshitz1, Osnat Zak2, Ur Metser1,3, Shlomo Schneebaum3,4 and Einat Even-Sapir1,3

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


Figure 1
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  		FIGURE 1.  SPECT/CT identification of site of nonnodal uptake misinterpreted as hot node on planar images in 57-y-old obese patient (BMI, 33.2 kg/m2) with nonpalpable mass. Labeled colloid injection was performed after insertion of guide wire during mammography. (A) Anterior and left lateral planar images of chest obtained with 57Co flood. These images were interpreted as identifying hot node in left axilla (arrow). (B and C) Transaxial (B) and coronal (C) SPECT/CT images. CT, SPECT, and fused images are shown from left to right. Hot spot was found to be tip of guide wire and not node (arrows). No other hot nodes were detected, and lymphoscintigraphy results were interpreted as negative. Intraoperative techniques also failed to identify SN, and patient underwent ALND; results of ALND were negative for malignancy.

 

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  		FIGURE 2.  Negative planar imaging and positive SPECT/CT identification of hot node in 64-y-old overweight patient (BMI, 29.1 kg/m2). (A) Anterior and left lateral planar images of chest obtained with 57Co flood. Except for uptake at injection site, no hot spot was identified. (B) SPECT/CT transaxial images. CT, SPECT, and fused images are shown from left to right. Hot node was detected at level I of left axilla (arrow), in keeping with SN. Increased uptake detected in left mediastinum appears to be nonnodal uptake in blood vessel.

 




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