Usefulness of Imaging Posture Using Modified Oblique View of the Axilla (MOVA) for Sentinel Lymph Node Scintigraphy in Patients with Breast Cancer

Ichihara, Hironori; Kinoshita, Fujimi; K, Hiyoshi; Beppu, Toshiko; Fujigasaki, Kaori

doi:10.6009/jjrt.kj00003174160

Cited by 5 publications

(4 citation statements)

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“…Consequently, identification of axillary SLNs was equivalent with MOVA and anterior view in 18 (24%) of 75 patients, was better with MOVA in 20 (26%) patients, and was achieved only with MOVA in 38 (50%) patients. Ichihara et al 13 confirmed the usefulness of MOVA, and proposed the combined application of MOVA and anterior view because SLN detection with γ-probe during surgery is performed in a supine position.…”

Section: Discussionmentioning

confidence: 91%

“…Some authors reported that addition of oblique view imaging to anterior view imaging in the conventional supine position improves the diagnostic accuracy. [11][12][13] On imaging, a lead shield is used to cover the injection site with a high level of radioactivity. However, use of a lead shield has a disadvantage in that it may cover lymph nodes on images.…”

Section: Introductionmentioning

confidence: 99%

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Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

et al. 2007

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Objective: To evaluate the advantage of upright position imaging with a medium-energy collimator for the detection of sentinel lymph node (SLN). Methods: Thirty-four patients with operable breast cancer underwent sentinel node lymphoscintigraphy with 99m Tc-tin colloid. Images were obtained in 5 different positions and paired images from the same patient were compared using side-by-side interpretation. Images were compared in 3 groups: group 1 (anterior view); supine (SAV) vs. upright (UAV), group 2 (oblique view); supine (SOV) vs. upright (UOV), and group 3 (oblique view); modified supine (MOV) vs. UOV. Image quality was evaluated using a 3-grade scale of clear, faint, and equivocal depiction, and correlated to 3 parameters: distance from injection site to lymph node (hot node), counts in hot node, and image contrast. Parameters in group 1 were compared by classifying the primary tumor site into 4 subregions. Results: Image quality in all 3 groups was more enhanced on the image obtained in the upright position than that in the supine position. Obtaining images in an upright position increased the mean distances by 1.5-3.2 cm, and mean contrasts were significantly increased by 0.13-0.31 (p < 0.05). It was shown that image quality was more greatly affected by image contrast than by counts in the hot node. Image contrast of 0.5 seemed an appropriate threshold level for detection of the hot node. On comparison of tumor sites, the upper outer quadrant (C) region of the 4 subregions demonstrated greater contrast enhancement on upright position images. Conclusion: Clinical images obtained in an upright position with a mediumenergy collimator were superior to those obtained in a supine position. Use of this procedure is recommended to enhance lymph node detection on sentinel node lymphoscintigraphy.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

et al. 2007

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“…For example, several papers [8][9][10][11][12] reported that modifying the imaging position improved the accuracy of SLN detection. As these methods increased the distance between the C region and axilla by modifying the imaging position, scattering from the injection site could be avoided.…”

Section: Figurementioning

confidence: 99%

“…To address this disadvantage, multiple methods [7][8][9][10][11][12][13][14][15][16][17][18] have been developed to minimize the effects of scattering and to improve SLN visibility during lymphoscintigraphy imaging. However, the use of these methods requires a new imaging in addition to as the usual imaging.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the subtraction method utilizing posterior view for improving visibility of the sentinel lymph nodes for lymphoscintigraphy in breast cancer

et al. 2016

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Objective: This study aimed to evaluate the usefulness of the subtraction method for improving sentinel lymph node (SLN) visibility by reducing scattering near the injection site.Methods: Images of two phantoms for the injection site and SLNs built using an original design were simultaneously acquired using a dual-head camera equipped with a low-energy high-resolution (LEHR) on the lower detector (posterior view) and a low-energy general-purpose (LEGP) collimator on the upper detector (anterior view). Subtraction method images were created by subtracting the posterior view from the anterior view, the latter of which was designated as the conventional method. Image contrast was calculated from the counts of regions of interest (ROI) placed on the two phantoms of the injection site and SLNs. SLNs visibility to a distance from the injection site and a radioactivity ratio based on the injection site (15 MBq) was evaluated by image contrast and visual interpretation.Results: The best improvement in contrast occurred at a distance of 20 pixels (1.08 mm/pixel) from the injection site, and improved further as the lymph node radioactivity is smaller. The SLNs visibility corresponding to a distance of 20 pixels improved significantly (p < 0.001), from 1/2560 of radioactivity at the injection site (approximately 6 kBq) to 1/640 (approximately 23 kBq), and SLN was only detectable using the subtraction method. SLN (1/5120, approximately 3 kBq) was difficult to detect even with the subtraction method, whereas SLN with a ratio ≥1/320 (approximately 46 kBq) was easily detected even with the conventional method. These visibilities did not differ significantly between the two methods (p = 0.16 and >0.32, respectively). The subtraction method could detect SLNs near the tumor on clinical images.Conclusions: The subtraction method improved SLN visibility near the injection site by reducing scattering from the injection site. Furthermore, an advantage of the subtraction method is that it does not require additional imaging because the posterior view is obtained simultaneously and utilized.

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Reverse echelon node and a lymphatic ectasia in the same patient during breast lymphoscintigraphy: the importance of injection and imaging technique

Kim

Shim²,

Kim³

et al. 2004

BJR

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Lymphoscintigraphy, along with triangulated patient body marking, can serve as a guide for surgeons during sentinel lymph node harvesting. Unique drainage patterns have been noted, especially with areolar or intradermal based injections, which are becoming increasingly popular. The images lymphoscintigraphy provide have been invaluable in delineating these patterns. The authors present a case that simultaneously illustrates two separate points in the same patient, a reverse echelon node and a lymphatic ectasia. To our knowledge, this combination has never been described in the same patient. Perilesional and areolar-cutaneous junction injections were performed sequentially and generated these patterns that could potentially have resulted in added morbidity and a false-negative sentinel node if not realised before surgery. Lymphoscintigraphy added valuable information in the management of this patient, which can occasionally present with complex patterns of activity during sentinel node harvesting.

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Usefulness of Imaging Posture Using Modified Oblique View of the Axilla (MOVA) for Sentinel Lymph Node Scintigraphy in Patients with Breast Cancer

Cited by 5 publications

References 0 publications

Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

Evaluation of the subtraction method utilizing posterior view for improving visibility of the sentinel lymph nodes for lymphoscintigraphy in breast cancer

Reverse echelon node and a lymphatic ectasia in the same patient during breast lymphoscintigraphy: the importance of injection and imaging technique

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