The yield of SPECT/CT for anatomical lymphatic mapping in patients with breast cancer

  • Iris M. C. van der Ploeg
  • Omgo E. Nieweg
  • Bin B. R. Kroon
  • Emiel J. T. Rutgers
  • Marie-Jeanne T. F. D. Baas-Vrancken Peeters
  • Wouter V. Vogel
  • Cornelis A. Hoefnagel
  • Renato A. Valdés Olmos
Original Article

Abstract

Purpose

The recently introduced hybrid single-photon emission computed tomography camera with integrated CT (SPECT/CT) fuses tomographic lymphoscintigrams with anatomical data from CT. The purpose of this study was to explore this sophisticated technique in lymphatic mapping in breast cancer patients.

Methods

We studied 134 patients who underwent SPECT/CT immediately after late planar imaging when these images showed an unusual drainage pattern (85 patients), a pattern that was difficult to interpret (27 patients), or nonvisualization (22 patients).

Results

Planar imaging suggested 271 sentinel nodes in 112 of the 134 patients (84%). SPECT/CT showed 269 of these same nodes and indicated that two sites of radioactivity were caused by skin contamination. SPECT/CT visualized 19 additional sentinel nodes in 15 patients, of whom 11 had non-visualization on planar images. One or more tumour-positive sentinel nodes were seen in 27 patients, and in 4 of these patients (15%), these were visualized only by SPECT/CT. SPECT/CT had no additional value for the surgical approach in 11 patients with persisting nonvisualization (8%), and was of questionable value in 67 other patients (50%). Based on the SPECT/CT images, a more precise incision was made in 48 patients (36%), an extra incision was made in 6 (4%), and an incision was omitted in 2 (1.5%).

Conclusion

SPECT/CT detected additional sentinel nodes and showed the exact anatomical location of sentinel nodes in breast cancer patients with inconclusive planar images. SPECT/CT was able to visualize drainage in patients whose planar images did not reveal a sentinel node. Therefore, SPECT/CT facilitates surgical exploration in difficult cases and may improve staging.

Keywords

Radionuclide imaging Breast neoplasms Sentinel lymph node biopsy Tomography Emission-computed Single-photon 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Iris M. C. van der Ploeg
    • 1
  • Omgo E. Nieweg
    • 1
  • Bin B. R. Kroon
    • 1
  • Emiel J. T. Rutgers
    • 1
  • Marie-Jeanne T. F. D. Baas-Vrancken Peeters
    • 1
  • Wouter V. Vogel
    • 2
  • Cornelis A. Hoefnagel
    • 2
  • Renato A. Valdés Olmos
    • 2
  1. 1.Department of SurgeryThe Netherlands Cancer Institute - Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of Nuclear MedicineThe Netherlands Cancer Institute - Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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