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Radioguided Surgery for Breast Cancer

Nuclear Oncology

  • 189 Accesses

Abstract

Sentinel lymph node biopsy is the standard surgical procedure for staging clinically tumor-free regional nodes in patients with early-stage breast cancer. This technique has spared the additional morbidity of axillary lymph node dissection without compromising diagnostic accuracy and prognostic information. However, it is still important to discuss current techniques and some controversies. Current data indicate that the combined radiocolloid injection approach (both superficial and deep injections) results in a higher identification rate of sentinel lymph nodes. Routine preoperative scintigraphic imaging helps the intraoperative search for sentinel lymph nodes and is vital for detecting extra-axillary or aberrant nodes, as well as for patients who have had prior core breast biopsy or surgery. SPECT/CT imaging, in addition to conventional lymphoscintigraphy, leads to improved preoperative visualization and localization of sentinel lymph nodes, especially if performed for specific indications. The combined use of radioactive tracers and blue dyes is more effective in detecting sentinel lymph nodes than either modality used alone and is therefore recommended for routine use.

Intraoperative imaging with portable gamma cameras is being increasingly employed, enhancing the reliability of the gamma probe by adding clear imaging of the surgical fields, especially when the injection site is close to the lymphatic basin. Portable gamma cameras can also be useful during radioguided occult lesion localization procedures in patients with non-palpable breast lesions.

Advances in radiopharmaceuticals and computer technology make it possible to integrate optical, hybrid tracers and 3D rendering systems that facilitate intraoperative sentinel lymph node identification.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-d-glucose

99mTc-MAA:

99mTc-macroaggregated albumin

ALND:

Axillary lymph node dissection

ART:

Axillary radiotherapy

ASCO:

Americal Society of Clinical Oncology

CT:

X-ray computed tomography

DCIS:

Ductal carcinoma in situ

FOV:

Field of view

GOSTT:

Guided intraoperative scintigraphic tumor targeting

H&E:

Hematoxylin and eosin staining

ICG:

Indocyanine green

IHC:

Immunohistochemistry staining

IMC:

Lymph nodes of the internal mammary chain

IMN:

Internal mammary lymph nodes

LEHR:

Low-energy high-resolution

LEUHR:

Low-energy ultra-high resolution

LN:

Lymph node

MRI:

Magnetic resonance imaging

NACT:

Neoadjuvant systemic chemotherapy

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

ROLL:

Radioguided occul lesion localization

SLN:

Sentinel lymph node

SLNB:

Sentinel lymph node biopsy

SNOLL:

Sentinel node occult lesion localization (a combined procedure of simultaneous SLNB and ROLL in the same surgical session)

SPECT:

Single photon emission computed tomography

SPECT/CT:

Single photon emission computed tomography/computed tomography

SPIO:

Superparamagnetic iron oxide

US:

Ultrasonography

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Authors and Affiliations

  1. Médecine Nucléaire – Groupement Hospitalier Est, Université Claude Bernard Lyon 1, 59, boulevard Pinel, 69677, Bron Cedex, France

    Francesco Giammarile

  2. Biophysique – Faculté Charles Mérieux Lyon, 165 chemin du Petit Revoyet, 69921, Oullins Cedex, France

    Francesco Giammarile

  3. Section of Nuclear Medicine, «Maggiore della Carità» University Hospital, Novara, Italy

    Federica Orsini

  4. Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands

    Renato A. Valdés Olmos

  5. Nuclear Medicine Department, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Renato A. Valdés Olmos

  6. Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain

    Sergi Vidal-Sicart

  7. Surgical Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai, Los Angeles, CA, USA

    Armando E. Giuliano

  8. Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy

    Giuliano Mariani

Authors
  1. Francesco Giammarile
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  2. Federica Orsini
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  3. Renato A. Valdés Olmos
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  4. Sergi Vidal-Sicart
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  5. Armando E. Giuliano
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  6. Giuliano Mariani
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Corresponding author

Correspondence to Francesco Giammarile .

Editor information

Editors and Affiliations

  1. Attending Emeritus, Memorial Sloan-Kettering Cancer Center Dept. Radiology, New York, New York, USA

    H. William Strauss

  2. Professor Emeritus, University of Pisa, Pisa, Italy

    Giuliano Mariani

  3. Associate Professor and Director of Nuclear Medicine, University of Pisa, Pisa, Italy

    Duccio Volterrani

  4. Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

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Giammarile, F., Orsini, F., Olmos, R.A.V., Vidal-Sicart, S., Giuliano, A.E., Mariani, G. (2016). Radioguided Surgery for Breast Cancer. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26067-9_28-1

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  • DOI: https://doi.org/10.1007/978-3-319-26067-9_28-1

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-26067-9

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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  1. Latest

    Radioguided Surgery for Breast Cancer
    Published:
    22 April 2022

    DOI: https://doi.org/10.1007/978-3-319-26067-9_28-2

  2. Original

    Radioguided Surgery for Breast Cancer
    Published:
    04 October 2016

    DOI: https://doi.org/10.1007/978-3-319-26067-9_28-1

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