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Lymphoscintigraphy and Sentinel Node Localization in Breast Cancer

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Lobar Approach to Breast Ultrasound

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Abstract

Breast cancer has always been an important indication for a great variety of nuclear medicine procedures. Lymphoscintigraphy used to play a role in the management of lymphedema of the arm and in locating the internal mammary nodes in the planning of radiation therapy. Lessons were learnt, which are relevant for the current use of the sentinel lymph node biopsy, namely, the great individual variability and the prognostic significance of pathological non-axillary lymph nodes.

The sentinel lymph node biopsy (SLNB) procedure is an important tool in surgical oncology for nodal staging of operable tumors. If the first draining node(s) is/are found to be free of tumor cells, more extensive nodal surgery, which may be associated with additional morbidity and complications, e.g., lymphedema, can be avoided.

However, in order to base the entire treatment policy on the analysis of a single or few lymph node(s), it is imperative that the correct lymph node is identified as the sentinel node. Nuclear medicine plays an essential role in the preoperative mapping of sentinel lymph nodes, which are subsequently resected, guided by an intraoperative gamma probe.

SPECT/CT is of great value for the detection and proper localization of sentinel nodes of breast cancer, especially if it concerns the localization of non-axillary sentinel nodes. It provides the surgeon the anatomical detail needed to approach and resect sentinel nodes. In case of no detection of a sentinel node by planar lymphoscintigraphy, the sentinel node can still be detected by SPECT/CT in half of the cases.

Although PET/CT and PET/MR using 18F-fluorodeoxyglucose (FDG) offer great sensitivity and accuracy for diagnosis, staging, restaging, and response monitoring in breast cancer, the sentinel node biopsy remains the best technique for nodal staging at the microscopic level.

It concluded that the SLNB is an important tool for staging breast cancer at the microscopic level. However, to ensure that the correct lymph node is identified and removed as “sentinel node,” it is imperative that preoperative imaging is optimized by every possible means. SPECT/CT is more sensitive and more accurate than planar lymphoscintigraphy, especially in locating non-axillary sentinel nodes, and this may influence the surgical approach.

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Authors and Affiliations

  1. Nuclear Medicine Consultant, Fazantstraat 38, 1171 HS Badhoevedorp, The Netherlands

    Cornelis A. Hoefnagel

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  1. Cornelis A. Hoefnagel
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Correspondence to Cornelis A. Hoefnagel .

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  1. Department of Radiology, Breast Center Department of Radiology, Aix-en-Provence, France

    Dominique Amy

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Hoefnagel, C.A. (2018). Lymphoscintigraphy and Sentinel Node Localization in Breast Cancer. In: Amy, D. (eds) Lobar Approach to Breast Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-61681-0_11

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  • DOI: https://doi.org/10.1007/978-3-319-61681-0_11

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