The Role of 99mTc-Tetrofosmin Pinhole-SPECT in Breast Cancer Axillary Lymph Node Staging

Spanu, Angela; Dettori, G; Chiaramida, Paola; Cottu, Pierina; Falchi, Antonio; Porcu, Alberto; Solinas, ME; Nuvoli, Susanna; Madeddu, Giuseppe

doi:10.1089/cbr.2000.15.81

Cited by 18 publications

(15 citation statements)

References 20 publications

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“…In the present study performed in patients with different variants of Kaposi’s sarcoma, we used the oncotropic radiotracer 99m Tc-tetrofosmin, which has proved useful in detecting many solid tumors [44, 45, 46, 47, 48, 49, 50], to evaluate whether this tracer could also be of value to identify both cutaneous and extracutaneous Kaposi lesions and whether it could also give additional information in respect of both clinical examination and other conventional diagnostic procedures.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of 99mTc-Tetrofosmin Scintigraphy in Different Variants of Kaposi’s Sarcoma

Spanu

Madeddu²,

Cottoni³

et al. 2003

Oncology

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We investigated ^99mTc-tetrofosmin scintigraphy in 27 patients with Kaposi’s sarcoma: 20 had classic (CK), 5 AIDS-associated (AK) and 2 transplantation-associated (TK) variants. Twenty-three patients had clinically evident cutaneous and/or mucosal lesions, 9 of them with associated sarcomatous lymphadenopathy; 2 TK patients had only lymph nodes or other extracutaneous Kaposi sites. Both planar and SPECT ^99mTc-tetrofosmin scintigraphies were performed in all cases and neck pinhole (P)-SPECT in selected patients. ^99mTc-tetrofosmin uptake was observed in 88% of patients with clinically evident cutaneous and/or extracutaneous Kaposi lesions. Scintigraphy gave additional information on cutaneous lesion extent, particularly SPECT regarding deep invasion and subclinical sites in some cases. However, scintigraphy was less sensitive in the detection of small, isolated and scattered lesions. SPECT/P-SPECT were positive in 8/8 patients with sarcomatous lymph nodes, planar imaging in 5/8, ultrasonography in 7/8, while all procedures were negative in 6 other patients with reactive or HIV infection lymph nodes. SPECT demonstrated lymphadenopathy remission in 1 TK patient after immunosuppressive therapy modification and, like planar imaging, ascertained an associated lymphoma with ⁶⁷Ga-citrate combined. ^99mTc-tetrofosmin scintigraphy, especially SPECT, can be useful both in the detection and staging of Kaposi sarcoma lesions as a complementary tool to clinical and other conventional diagnostic methods.

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Section: Discussionmentioning

confidence: 99%

“…The cationic lipophilic agent 99m Tc-tetrofosmin has proved useful as an oncotropic radiotracer in the detection of many solid neoplasms and their metastases [45, 46, 47, 48, 49, 50, 51], and its presence has been demonstrated in tumor cells by ‘in vitro’ studies [52, 53]. …”

Section: Introductionmentioning

confidence: 99%

Usefulness of 99mTc-Tetrofosmin Scintigraphy in Different Variants of Kaposi’s Sarcoma

Spanu

Madeddu²,

Cottoni³

et al. 2003

Oncology

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“…Results are presented for 3.0 and 4.0 mm object resolutions in the images for object-to-collimator distances between 1 and 10 cm. The pinhole collimator was assumed to be fabricated with an 18.0 g/cm 3 tungsten alloy and sensitivities were computed on the collimator axis. The parallel hole collimator was assumed to be lead with square holes in a square grid and the allowable septal penetration factor β was 0.05.…”

Section: Comparison Of Pinhole and Parallel Hole Collimationmentioning

confidence: 99%

“…INTRODUCTION Parallel hole collimation [1] and pinhole collimation [2,3] have been employed for scintimammography with standard gamma cameras. Pinhole collimation with object magnification permits image resolution that is better than the intrinsic resolution of the detector.…”

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confidence: 99%

Optimizing pinhole and parallel hole collimation for scintimammography with compact pixellated detectors

Smith

Kieper

Majewski

et al. 2003

IEEE Trans. Nucl. Sci.

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Abstract-The relative advantages of pinhole and parallel hole collimators for scintimammography with compact, pixellated gamma detectors were investigated using analytic models of resolution and sensitivity. Collimator design was studied as follows. A desired object resolution was specified for a pixellated detector with a given crystal size and intrinsic spatial resolution and for a given object-to-collimator distance. Using analytic formulas, pinhole and parallel hole collimator parameters were calculated that satisfy this object resolution with optimal geometric sensitivity. Analyses were performed for 15 cm x 20 cm field of view detectors with crystal elements 1.0, 2.0 and 3.0 mm on a side and 140 keV incident photons. The sensitivity for a given object resolution was greater for pinhole collimation at smaller distances, a s expected. The object distance at which the pinhole and parallel hole sensitivity curves cross each other is important. The crossover distances increased with larger crystal size for a constant object resolution and increased as the desired object resolution decreases for a constant crystal size. For example, for 4 mm object resolution these distances were 5.5 cm, 6.5 cm and 8 cm for the 1 mm, 2 mm and 3 mm crystal detectors, respectively. The results suggest a strategy of parallel hole collimation for whole breast imaging and pinhole collimation for imaging focal uptake. This could be accomplished with a dual detector system with a different collimator type on each head or a single head system equipped with two collimators and a rapid switching mechanism. Multipinhole collimators have the potential to increase sensitivity yet maintain high image resolution. An experimental SPECT phantom study with a four-pinhole collimator was acquired with a pixellated detector. The iterative maximum-likelihood expectationmaximization (MLEM) reconstruction of a hot sphere in a warm cylinder showed the potential of multipinhole collimation to improve sensitivity for tomographic pinhole scintimammography.

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“…23,24 More recently, we have also employed SPECT with a pinhole collimator (P-SPECT); this imaging procedure has provided more resolution in the identification of metastatic axillary nodes and has also provided more prognostic information. 25 The aim of the present study was to perform a comparative evaluation between radioguided SN biopsy and 99m Tc-Tetrofosmin axillary P-SPECT in predicting axillary lymph node status in breast cancer patients, thus also improving the selection of patients to submit to ALND.…”

Section: Introductionmentioning

confidence: 99%

^99mTc-Tetrofosmin Pinhole-SPECT (P-SPECT) and Radioguided Sentinel Node (SN) Biopsy and in Breast Cancer Axillary Lymph Node Staging

Spanu

Dettori

Chessa

et al. 2001

Cancer Biotherapy and Radiopharmaceuticals

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We compared 99mTc-Tetrofosmin P-SPECT with radioguided SN biopsy in 101 T1/T2 BC pts to predict axillary lymph node status. The day before surgery all pts underwent lymphoscintigraphy (LS) to mark the SN, following subdermal injection of 99mTc-colloidal sulphur surrounding the breast lesion. LS was combined with pre and intraoperative gamma probe. Previously, all pts had also undergone P-SPECT. ALND was performed in all cases. The SN(s) was detected in 97/101 cases (96%) by LS and gamma probe; in the 4 missed cases P-SPECT predicted lymph node status. In the 97 comparable cases, radioguided SN biopsy showed a slightly higher accuracy than P-SPECT (94.8% vs 93.8%), but a higher false-negative rate (14.3% vs 8.6%); P-SPECT had a higher NPV (95.2% vs 92.5%). The two procedures when combined achieved 100% accuracy. Radioguided SN biopsy alone had 100% accuracy only in pts with BC < 15 mm. P-SPECT had 3 false negative cases, 2 of which were micrometastatic SNs, and 3 false positives. P-SPECT identified 81.2% of cases with a single node, determined the exact number of nodes in 82.6% of cases with 1 to 3 node and correctly classified 93.7% of pts as having < or = 3 or > 3 metastatic nodes. Radioguided SN biopsy seems indicated in selected, early stage, small BC pts, while P-SPECT shows a high sensitivity independent of primary tumor size, giving additional important preoperative prognostic information. The two procedures combined provided a better axillary lymph node status prediction in T1/T2 carcinomas, and could thus improve ALND pt selection.

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The Role of ^99mTc-Tetrofosmin Pinhole-SPECT in Breast Cancer Axillary Lymph Node Staging

Cited by 18 publications

References 20 publications

Usefulness of <sup>99m</sup>Tc-Tetrofosmin Scintigraphy in Different Variants of Kaposi’s Sarcoma

Usefulness of <sup>99m</sup>Tc-Tetrofosmin Scintigraphy in Different Variants of Kaposi’s Sarcoma

Optimizing pinhole and parallel hole collimation for scintimammography with compact pixellated detectors

^99mTc-Tetrofosmin Pinhole-SPECT (P-SPECT) and Radioguided Sentinel Node (SN) Biopsy and in Breast Cancer Axillary Lymph Node Staging

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