Role of SPECT/CT in Sentinel Lymph Node Detection in Patients With Breast Cancer

Vercellino, Laëtitia; Ohnona, Jessica; Groheux, David; Slama, Abdelhak; Colletti, Patrick M.; Chondrogiannis, Sotirios; Merlet, Pascal; Toubert, Marie‐Elisabeth; Rubello, Domenico

doi:10.1097/rlu.0b013e31829af8c0

Cited by 30 publications

(21 citation statements)

References 36 publications

(45 reference statements)

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“…These visualization rates are in accordance with the reported 63%-88% for breast cancer (14,16,17), 82%-99% for melanoma (18), and 84%-91% for gynecologic and prostate cancers (6,7,21). SPECT/CT improved the visualization rates to 91.3% for breast cancer, 99.2% for melanoma, and 95.3% for pelvic cancer, again in agreement with the reported rates of 81%-97.3% for breast cancer (16)(17)(18), near 100% for melanoma (18), and 92.2%-100% for gynecologic and prostate cancers (6,7,21,22). SPECT/CT depicted SNs in 3.7% of breast cancer, 0.4% of melanoma, and 4.7% of pelvic cancer patients, respectively, with no SNs visualized on PI, representing a considerable number of patients who would have undergone lymphadenectomy if only PI was performed.…”

Section: Discussionsupporting

confidence: 78%

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Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies

et al. 2015

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We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, melanoma, and pelvic tumors. Methods: From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of 99m Tccolloid particles. Surgery was performed the same or next day. Results: Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P , 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer. Conclusion: SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI. The status of regional lymph nodes is a major prognostic factor in many malignant tumors. Sentinel lymph node (SN) biopsy in patients with clinically node-negative tumors is a validated technique for accurate staging of nodal disease in breast cancer (1,2) and melanoma (3,4) and is being used with promising results in other solid tumors including pelvic malignancies (5,6). The use of SN mapping in an increasing list of tumors shows a variety of lymphatic drainage basins containing the SN (7). SNs are the lymph nodes draining the primary tumor and therefore the most likely to contain tumor cells spreading to the drainage basin (8). Assuming an orderly progression of lymph flow, the tumor status of the SN predicts the status of the regional draining basin (1). Selective SN biopsy enables the detection of metastatic and occult micrometastatic nodal involvement by thorough histopathologic examination in the intraoperative setting, sparing patients a systematic regional lymphadenectomy when the node is negative.Planar lymphoscintigraphy (PI) after local injection of radiocolloid is well suited for the mapping of regional lymph nodes, but occasionally no SNs are visualized, for instance, in obese patients or when SNs are located too close to the injection site. In addition, the anatomic information provided by planar scintigraphy is limited and the exact SN location is difficult to define in deeply located nodes (9,10). Unexpected basin drainage sites and unpredictable pathways also hinder interpretation of planar images. Because of its superior contrast, resolution, and display of exact anatomic landmarks, SPECT...

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Section: Discussionsupporting

confidence: 78%

“…Unexpected basin drainage sites and unpredictable pathways also hinder interpretation of planar images. Because of its superior contrast, resolution, and display of exact anatomic landmarks, SPECT/CT can overcome most of these limitations (11)(12)(13)(14)(15)(16)(17)(18).…”

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confidence: 99%

Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies

et al. 2015

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“…İnternal mammaryel lenf bezi diseksiyonunun her merkez tarafından yapılmadığı göz önünde bulundurulduğunda SPECT/BT'nin katkısının sınırlı olacağını bildiren yayınlar da vardır. Meme kanserli hastalar üzerinde yapılmış 11 çalışmanın metaanalizinde SPECT/BT kullanıldığında SLB saptamadaki doğruluğun %63-88'den %89-97'ye yükseldiği; ancak verdiği radyasyon dozu da göz önünde bulundurularak seçilmiş olgularda uygulanmasının daha doğru olacağı bildirilmiştir (59). İntraabdominal hastalıklarda lenf bezi haritalamanın ve cerrahinin daha karmaşık olması nedeni ile SLB saptamada 3 boyutlu görüntülemenin yeri daha fazladır.…”

Section: Spectvespect/btgörüntülemeunclassified

Sentinel Lymph Node Biopsy: Actual Approaches

Tuncel¹,

Salancı²,

Bozkurt³

2017

Nts

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Öz Abstract GirişKanser yayılımında en önemli yollardan biri lenfatik yayılımdır. On yedinci yüzyılda lenfatik sistemin tanımlanması ve ardından kanserdeki rolünün saptanmaya başlaması ile bu konuda çeşitli çalışmalar yapılmıştır. Bu araştırmaların sonucunda bugün kanserin yerleştiği bölgeye bağlı olarak önce bölgesel lenf bezlerine ilerlediği ve klinik tanıdan çok daha önce bu bölgesel lenf bezlerinde mikrometastazların gerçekleştiği bilinmektedir. Bu bilgi özellikle meme kanseri ve malign melanom gibi kanserlerde sentinel lenf bezi (SLB) kavramının doğmasını sağlamıştır (1). İlk SLB tanımı Cabanas tarafından penil kanserde yapılmıştır (2). Lenfosintigrafinin SLB saptanmasında kullanılması Chiappa ve ark.'nın 1966'da testiküler kanserlerde yaptığı çalışma ile başlamıştır (3). Morton ve ark.'nın 194 malign melanom hastasında lenfosintigrafi kullanılarak lenfatik yayılımın araştırdığı çalışma SLB'nin örneklemesinin önünü açmış olup, günümüzde SLB sintigrafisi rutin uygulama kılavuzlarında yerini almıştır (4). Meme kanserlerinde de Christensen ve ark. ile başlayan çalışmalar koruyucu meme cerrahisi uygulamalarının yaygınlaşmasına ve hastaların daha az cerrahi komplikasyon ile tedavi edilmelerine olanak vermiştir (5). Son yıllarda gelişen görüntüleme ve intraoperatif deteksiyon teknolojileri sayesinde SLB biyopsisinin (SLBB) başarısı ve kullanım sıklığı

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“…Using the SPECT/CT technique in SLNB leads to a slight increase in an effective dose (SPECT effective dose is about 1 mSv for 50 MBq 99m Tc-nanocolloid and the total effective dose SPECT/CT is up to 3mSv according to Law 57 ), thus the use of a hybrid system should always be justified by the expected benefit [58][59][60][61][62] . A low-dose CT scan can help keep the radiation dose to a minimum.…”

Section: Radiation Burden and The Need For Justification For Performimentioning

confidence: 99%

SPECT/CT imaging in breast cancer - current status and challenges

Simanek

Koranda²

2016

BIOMED PAP

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Background. The increasing incidence of breast cancer worldwide raises the importance of improving imaging techniques for disease stratification after early lesion detection. SPECT/CT imaging is now widely available but its diagnostic potential is not fully utilized for more specific purposes including breast cancer patient stratification. Methods and Results. A Pubmed search for both original and review articles related to the value of SPECT/CT in breast cancer patients and comparison to other diagnostic methods. 62 articles were found using the key words SPECT/CT, Fusion Image and Breast Cancer. Development of a new generation of SPECT/CT systems and their introduction into practice has changed the old diagnostic algorithm. The increasing importance of SPECT/CT in the detection of bone metastases is confirmed. The diagnostic accuracy of new SPECT/CT instruments in the diagnostics of bone metastases is nearly comparable to PET/CT scans. SPECT/CT is more widely available and costs less than PET. It is able not only to identify a sentinel lymph nodes in atypical localizations but also to detect sentinel lymph nodes non visualized on previous planar scans. SPECT/CT offers precise anatomic localization of sentinel lymph nodes, thereby facilitating surgery. Knowledge of precise sentinel lymph node localization can also be applied in radiotherapy. Conclusions. The role of hybrid SPECT/CT imaging in breast cancer patients is changing. It is a powerful modality for skeletal and nodal staging in breast cancer patients with important impact on therapy.

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Role of SPECT/CT in Sentinel Lymph Node Detection in Patients With Breast Cancer

Abstract: SPECT/CT is a valuable tool for SLND, especially in difficult cases, when planar lymphoscintigraphy shows no SLN or unexpected lymphatic drainage.

Cited by 30 publications

References 36 publications

Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies

Results of a Prospective Multicenter International Atomic Energy Agency Sentinel Node Trial on the Value of SPECT/CT Over Planar Imaging in Various Malignancies

Sentinel Lymph Node Biopsy: Actual Approaches

SPECT/CT imaging in breast cancer - current status and challenges

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