Single-Photon Emission Computed Tomography/Computed Tomographyfor Sentinel Node Mapping in Breast Cancer

https://doi.org/10.1053/j.semnuclmed.2006.08.001Get rights and content

Accurate lymph node staging is essential for the prognosis and treatment in patients with cancer. The sentinel lymph node is the first node to which lymphatic drainage and metastasis from the primary tumor occurs. In malignant melanoma and breast cancer, the sentinel lymph node detection and biopsy already have been implemented into clinical practice. Currently, 2 techniques are used to identify the sentinel lymph nodes: technetium-99m-labeled colloid and blue dye. After peritumoral injection, the material migrates through the lymphatics to the first lymph nodes draining the tumor. The precise anatomic localization of the sentinel lymph nodes is important for minimal invasive surgery and to avoid incomplete removal of the sentinel lymph nodes. All sentinel lymph nodes should be resected to achieve a complete nodal staging. In the inguinal or low-axillary nodal stations, planar scintigraphic images mostly are adequate for the localization of the sentinel lymph nodes. However, in the regions of the head and neck, the chest, and the pelvis, an imaging method for the more precise anatomic localization of the sentinel lymph nodes preoperatively is highly desired. Recently, integrated single-photon emission computed tomography and computed tomography (SPECT/CT) scanners have become available. Initial reports suggest that integrated SPECT/CT might have an additional value in sentinel lymph node scintigraphy in head and neck tumors and tumors draining to the pelvic lymph nodes. We evaluated the clinical use of integrated SPECT/CT in the identification of the sentinel lymph nodes in patients with operable breast cancer. In our experience, localization and identification of sentinel lymph nodes was more accurate by integrated SPECT/CT imaging in comparison with planar images and SPECT images, respectively. In this report, the experiences of sentinel lymph node imaging with SPECT/CT are summarized.

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Our Experience With SPECT/CT Imaging for SN Mapping in Breast Cancer

The gynecologists at our institution routinely use SN scintigraphy in breast cancer patients for preoperative SN mapping. To evaluate the additional value of multimodal, multiplanar images for SN mapping, we performed SPECT/CT imaging in addition to the planar images in 41 consecutive patients (mean age, 55 years; range, 26-80 years) with breast cancer. All patients were planned for breast surgery and SN biopsy (tumor size ranging from 2 to 30 mm). All patients had a clinically negative axilla,

SPECT/CT Compared With Planar Images

SPECT/CT showed more accurate information in 34 patients (82%). The localization and number of SN was exactly the same in only 7 patients (17%). All these 7 patients had one Level I SN. In 29 patients (70%), the exact anatomical localization was equivocal on planar images, whereas SPECT/CT showed the exact anatomical information needed to assign the SN Levels according to the American Joint Committee on Cancer (AJCC). In 6 patients (14%), SNs close to the injection site were detected with

Experience of Other Groups With SPECT/CT Imaging for SN Mapping

There is only little literature dealing with SPECT/CT for SN mapping. In 2003, Kretschmer and coworkers7 performed SPECT and the image fusion technique with CT in 29 patients with malignant melanoma. They found SPECT/CT to be an excellent tool to anatomically localize the SN in malignant melanoma draining to the pelvic region. With planar images of the pelvis, the exact anatomical localization of the pelvic SN cannot be given. It is crucial to examine the lymph nodes because they can contain

Discussion

Our results with SPECT/CT for SN mapping of breast cancer and the results of other groups with SPECT/CT for SN mapping in the head and neck and the pelvis indicate that the combination of lymphoscintigraphy and integrated SPETCT/CT imaging improves the anatomic localization and the identification of the SN. In our study, integrated SPECT/CT was clearly superior to SPECT alone or planar images, especially with regard to exact anatomical localization of the SN. The identification of intramammary

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