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Axillary lymph node staging in breast cancer: clinical value of single photon emission computed tomography-computed tomography (SPECT-CT) with 99mTc-methoxyisobutylisonitrile

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Abstract

Objective

To determine diagnostic accuracy of SPECT, CT and SPECT-CT in axillary lymph node (LN) staging in breast cancer (BC).

Methods

Sixty consecutive patients with primary operable T1-3NxM0 BC were included in this study. All patients underwent SPECT-CT examination on Symbia-T16 scanner which consists of dual-head gamma camera combined with 16 slices diagnostic CT. SPECT-CT acquisition started 10–15 min after i/v injection of 740–1,000 MBq of 99mTc-MIBI. On CT images of axillary LN we analyzed following diagnostic signs: size (short axis more or less than 10 mm), shape (round or oval), cortical thickness and fat content (solid or with fat gate). Intensity of tracer uptake in axillary LN was classified as follows: grade (Gr) I—background, Gr II—slightly above background, Gr III—intense but below uptake in muscles, Gr IV—as high as in muscles. Histological examination of dissected LN was used as gold standard.

Results

Various combinations of CT signs of axillary LN involvement demonstrated moderate diagnostic value with best results characterized by low (55 %) sensitivity (SEN), 97 % specificity (SP) and 83 % accuracy (AC). Intensive (Gr IV) uptake of 99mTc-MIBI in axillary LN characterized by low (55 %) SEN, high (100 %) SP and moderate (84 %) AC. Combination of CT and SPECT signs looks most promising especially when LN metastases were diagnosed in patients with enlarged solid LN or normal sized LN with Gr III-IV 99Tc-MIBI uptake. In these cases, SEN was equal to 75 %, SP-90 %, AC-85 %, only one of 5 patients with false negative results had metastases in more than 2 LN.

Conclusions

By combination of SPECT and CT data we can more accurately diagnose axillary LN invasion by breast cancer.

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Conflict of interest

The authors declare that they have no conflict of interests.

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Authors and Affiliations

  1. Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, St Petersburg, 197758, Russia

    Sergey Nikolaevich Novikov, Pavel Ivanovich Krzhivitskii, Sergey Vasilevich Kanaev, Nikolay Dmirievich Ilin, Ludmila Alexeevna Jukova & Olga Igorevna Ponomareva

  2. Surgery Department No 1, N.N. Petrov Institute Oncology, Leningradskaya 68, St Petersburg, 197758, Russia

    Petr Vladimirovich Krivorotko

Authors
  1. Sergey Nikolaevich Novikov
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  2. Pavel Ivanovich Krzhivitskii
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  3. Sergey Vasilevich Kanaev
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  4. Petr Vladimirovich Krivorotko
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  5. Nikolay Dmirievich Ilin
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  6. Ludmila Alexeevna Jukova
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  7. Olga Igorevna Ponomareva
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Correspondence to Sergey Nikolaevich Novikov.

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Novikov, S.N., Krzhivitskii, P.I., Kanaev, S.V. et al. Axillary lymph node staging in breast cancer: clinical value of single photon emission computed tomography-computed tomography (SPECT-CT) with 99mTc-methoxyisobutylisonitrile. Ann Nucl Med 29, 177–183 (2015). https://doi.org/10.1007/s12149-014-0926-6

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  • DOI: https://doi.org/10.1007/s12149-014-0926-6

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