The Usefulness of SPECT/CT in Sentinel Node Mapping of Early Stage Breast Cancer Patients Showing Negative or Equivocal Findings on Planar Scintigraphy

Siddique, Maimoona and Nawaz, Muhammad Khalid and Bashir, Humayun (2018) The Usefulness of SPECT/CT in Sentinel Node Mapping of Early Stage Breast Cancer Patients Showing Negative or Equivocal Findings on Planar Scintigraphy. Asia Oceania Journal of Nuclear Medicine and Biology, 6 (2). pp. 80-89.

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Objective(s): This study sought to determine the diagnostic yield of SPECT/CTin localizing axillary sentinel lymph nodes (SLNs) in early breast cancer patientswhere planar scintigraphy (PS) was equivocal or negative.Methods: Prospective analysis of early stage breast cancer patients with nonpalpableaxillary nodes undergoing SLN localization prior to nodal sampling foraxillary staging. PS findings were categorized as: Category A: non-visualizationof SLN; Category B: unusual uptake location; Category C: equivocal uptake /difficult interpretation. The K-coefficient of Cohen was used to evaluate thecorrelation between PS and SPECT/CT results. PS and SPECT/CT images wereinterpreted separately, and SLN identification on each of the modalities wascorrelated to BMI (Body mass index) and peroperative radio guided results.Results: Between April 2015 and January 2017, 1028 early breast cancer casesunderwent sentinel lymphoscintigraphy. Of total, 134 (13) patients underwentSPECT/CT in addition to PS. All were females with mean age of 48.15 years (range:26-82 years). Right sided in 68, left in 64 and 2 with bilateral carcinoma. By TNMclassification: 49 (37) T1, 78 (58) T2 and 7 (5) had DCIS/Paget’s disease.Overall SLNs were detected on both PS and SPECT/CT in 60 cases. Of categoryA (n=54); 35/54 (64) SLN localized on SPECT/CT; 32 were level-I; 2 Level-II;1 Level-III nodes. In 19, SLN was not localized. Of category B (n=18), 5 hadprior lumpectomy, SPECT/CT localized tracer uptake to 17 level-I sentinelnodes, 3 level-II and level III / IMC in 9.Of category C (n=62), 29 had prior lumpectomy. SPECT/CT confirmed SLN in allthe cases. Radio-guided surgery confirmed SPECT/CT results. The correlationbetween the two techniques was low (K=0.34). Where PS was negative; SPECT/CT localized nodes in statistically significant number of cases (P=0.01). PSidentified SLN uptakes in 80/134 (60) cases with a mean BMI of 21.6±4.8 kg/m2 while SPECT/CT detected ‘‘hot’’ nodes in 115/134 (86) cases with a meanBMI of 29.6±5.6 kg/m2. For overweight/obese patients (n=59) (BMI>25 kg/m2),PS failed to identify SLNs in 49 and SPECT/CT failed to do so in 18 (P<0.001).Conclusion: SPECT/CT has diagnostic yield and helps in precise SLN localizationwhere planar imaging is negative or shows unusual site of uptake.

Item Type: Article
Subjects: WN Radiology . Diagnostic Imaging
Divisions: Journals > Asia Oceania J Nuclear Medicine & Biology
Depositing User: AOJNMB AOJNMB
Date Deposited: 18 Jun 2018 06:10
Last Modified: 18 Jun 2018 06:10

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