Article Figures & Data
Figures
- 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.
- 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.
- 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.
- 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.
Tables
Parameter n* Age (y) Median 59 Range 29–81 Primary tumor size (cm) Median 1.5 Range 0.4–7.1 Primary tumor type Invasive 71 (93) Infiltrating ductal 63 Infiltrating lobular 6 Other 2 Noninvasive 5 (7) Ductal carcinoma in situ 5 Location Outer quadrants 37 (49) Upper 27 Lower 10 Inner quadrants 38 (50) Upper 25 Lower 13 Subareolar 1 (1) Method of biopsy Fine-needle aspiration 21 (28) Core needle 19 (25) Excision 36 (47) ↵* Values in parentheses are percentages.
n Primary drainage Secondary drainage 58 AX None 8 AX IM 2 AX CL 1 AX + IM None 1 AX + IM + CL None 1 IM None 4 IM AX 1 CL AX - TABLE 3.
Effect of 6 Factors on Radiopharmaceutical Transit Time Determined by Logistic Regression
Factor P Inner quadrants vs. outer quadrants* 0.91 Interval from biopsy to lymphoscintigraphy (d) 0.77 Method of biopsy (FNA vs. core vs. excision) 0.45 Age (y, continuous variable) 0.45 Weight (kg, continuous variable) 0.31 Breast size Small vs. medium 0.93 Large vs. small 0.01 Large vs. medium 0.03 ↵* 1 subareolar case excluded.
FNA = fine-needle aspiration.
- TABLE 5.
Summary of Techniques and Drainage Patterns in SLND Series Using Breast Lymphoscintigraphy
Study n Agent Total MBq Total injection volume* (mL) Early/late scan timing after injection (h) Views Overall sentinel node detection (%) AX drainage† (%) IM drainage† (%) Total Exclusive Total Exclusive Uren et al. (12) 34 ASC 50–70 0.2–0.4 0/2.5 A, L, O 91 94 58 39 6 Roumen et al. (10) 83 CA 60 2 4/18 A, L 80 97 86 11 3 De Cicco et al. (9) 250 CA or ASC 7 0.4 or 0.5‡ 0.25–0.5/3 A, AO 98 98 98 2 2 Borgstein et al. (7) 130 CA 40 4 2/18 A, L 91 98 81 18 2 O'Hea et al. (8) 56 SC 11 4 0.8–1§ A, L 75 100 86 14 0 van der Ent et al. (11) 70 NC 370 4 16§ A, AL NR 97 NR 34 NR Current series 76 SC 12–16 3–8 0/¶ A, MOVA 100 99 79 20 1 ↵* All injections were peritumoral except for series from De Cicco (9).
↵† Values represent drainage patterns after scan failures were excluded.
↵‡ 0.4 mL for subdermal injection (175 patients) and 0.5 mL for peritumoral injection (75 patients).
↵§ Only 1 scan obtained at these times.
↵¶ Images obtained continuously until sentinel node visualized, unless no uptake after 4 h.
A = anterior; L = lateral; O = oblique; CA = colloidal albumin; AO = antero-oblique; SC = sulfur colloid; NC = nanocolloid; AL = anterolateral; NR = not recorded.
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