Nuclear Medicine and Molecular Imaging

, Volume 49, Issue 1, pp 26–32 | Cite as

The Clinical Value of Hybrid Sentinel Lymphoscintigraphy to Predict Metastatic Sentinel Lymph Nodes in Breast Cancer

  • Chang Ju Na
  • Jeonghun Kim
  • Sehun Choi
  • Yeon-Hee Han
  • Hwan-Jeong Jeong
  • Myung-Hee Sohn
  • Hyun Jo Youn
  • Seok Tae LimEmail author
Original Article



Hybrid imaging techniques can provide functional and anatomical information about sentinel lymph nodes in breast cancer. Our aim in this study was to evaluate which imaging parameters on hybrid sentinel lymphoscintigraphy predicted metastatic involvement of sentinel lymph nodes (SLNs) in patients with breast cancer.


Among 56 patients who underwent conventional sentinel lymphoscintigraphy, 45 patients (age, 53.1 ± 9.5 years) underwent hybrid sentinel lymphoscintigraphy using a single-photon emission computed tomography (SPECT)/computed tomography (CT) gamma camera. On hybrid SPECT/CT images, we compared the shape and size (long-to-short axis [L/S] ratio) of the SLN, and SLN/periareolar injection site (S/P) count ratio between metastatic and non-metastatic SLNs. Metastatic involvement of sentinel lymph nodes was confirmed by pathological biopsy.


Pathological biopsy revealed that 21 patients (46.7 %) had metastatic SLNs, while 24 (53.3 %) had non-metastatic SLNs. In the 21 patients with metastatic SLNs, the SLN was mostly round (57.1 %) or had an eccentric cortical rim (38.1 %). Of 24 patients with non-metastatic SLNs, 13 patients (54.1 %) had an SLN with a C-shape rim or eccentric cortex. L/S ratio was 2.04 for metastatic SLNs and 2.38 for non-metastatic SLNs. Seven (33 %) patients had T1 primary tumors and 14 (66 %) had T2 primary tumors in the metastatic SLN group. In contrast, 18 (75 %) patients had T1 primary tumors and six (25 %) had T2 tumors in the non-metastatic SLN group. S/P count ratio was significantly lower in the metastatic SLN group than the non-metastatic SLN group for those patients with a T1 primary tumor (p = 0.007).


Hybrid SPECT/CT offers the physiologic data of SPECT together with the anatomic data of CT in a single image. This hybrid imaging improved the anatomic localization of SLNs in breast cancer patients and predicted the metastatic involvement of SLNs in the subgroup of breast cancer patients with T1 primary tumors.


Hybrid sentinel lymphoscintigraphy Sentinel lymph nodes Breast cancer Metastatic prediction 



This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health, Welfare and Family Affairs, Republic of Korea (No. 0620220). This work was also supported by a grant from the Nuclear Research & Development Program of the National Research Foundation of Korea (NRF) funded by the Korean government (No. 2009–0078422).

Conflict of Interest

Chang Ju Na, Jeonghun Kim, Sehun Choi, Yeon-Hee Han, Hwan-Jeong Jeong, Myung-Hee Sohn, H yun Jo Youn, and Seok Tae Lim declare that they have no conflict of interest.

Ethics Statement

This study was approved by the ethics committee in our institution and was performed in accordance with the Helsinki Declaration of 1975, as revised in 2000. All patients enrolled gave their informed consent prior to their inclusion in the study.


  1. 1.
    Banerjee M, George J, Song EY, Roy A, Hryniuk W. Tree-based model for breast cancer prognostication. J Clin Oncol. 2004;22:2567–75.CrossRefPubMedGoogle Scholar
  2. 2.
    Krag DN, Weaver DL, Alex JC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2:335–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Giuliano AE, Kirgan DM, Guenther JM, Morton D. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–401.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer: a multicenter validation study. N Engl J Med. 1998;339:941–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Husarik DB, Steinert HC. Single-photon emission computed tomography/computed tomography for sentinel node mapping in breast cancer. Semin Nucl Med. 2007;37:29–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Kraft O, Havel M. Localisation of sentinel lymph nodes in patients with melanomas by planar lymphoscintigraphy and hybrid SPECT/CT imaging. Nucl Med Rev Cent East Eur. 2012;15:101–7.PubMedGoogle Scholar
  8. 8.
    Keidar Z, Israel O, Krausz Y. SPECT/CT in tumor imaging: technical aspects and clinical applications. Semin Nucl Med. 2003;33:205–18.CrossRefPubMedGoogle Scholar
  9. 9.
    Wagner A, Schicho K, Glaser C, Zettinig G, Yerit K, Lang S, et al. SPECT-CT for topographic mapping of sentinel lymph nodes prior to gamma probe-guided biopsy in head and neck squamous cell carcinoma. J Craniomaxillofac Surg. 2004;32:343–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Even-Sapir E, Lerman H, Lievshitz G, Khafif A, Fliss DM, Schwartz A, et al. Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT System. J Nucl Med. 2003;44:1413–20.PubMedGoogle Scholar
  11. 11.
    Van der Ploeg IM, Nieweg OE, Kroon BB, Rutgers EJ, Baas-Vrancken Peeters MJ, Vogel WV, et al. The yield of SPECT/CT for anatomical lymphatic mapping in patients with breast cancer. Eur J Nucl Med Mol Imaging. 2009;36:903–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Imoto S, Murakami K, Ikeda H, Fukukita H, Moriyama N. Mammary lymphoscintigraphy with various radiopharmaceuticals in breast cancer. Ann Nucl Med. 1999;13:325–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Pelosi E, Bello M, Giors M, Ala A, Giani R, Bussone R, et al. Sentinel lymph node detection in patients with early-stage breast cancer: comparison of periareolar and subdermal/peritumoral injection techniques. J Nucl Med. 2004;45:220–5.PubMedGoogle Scholar
  14. 14.
    Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227:645–53.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Lee HS, Kim SW, Kim BH, Jung SY, Lee S, Kim TS, et al. Predicting nonsentinel lymph node metastasis using lymphoscintigraphy in patients with breast cancer. J Nucl Med. 2012;53:1693–700.CrossRefPubMedGoogle Scholar
  16. 16.
    Wang L, Yu J, Wang Y, Zuo W, Gao Y, Fan J, et al. Preoperative lymphoscintigraphy predicts the successful identification but is not necessary in sentinel lymph nodes biopsy in breast cancer. Ann Surg Oncol. 2007;14:2215–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Noguchi A, Onoguchi M, Ohnishi T, Hashizume T, Kajita A, Funauchi M, et al. Predicting sentinel lymph node metastases in breast cancer with lymphoscintigraphy. Ann Nucl Med. 2011;25:221–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Yoshimura G, Sakurai T, Oura S, Suzuma T, Tamaki T, Umemura T, et al. Evaluation of axillary lymph node status in breast cancer with MRI. Breast Cancer. 1999;6:249–58.CrossRefPubMedGoogle Scholar
  19. 19.
    Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63:181–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Chung MH, Ye W, Giuliano AE. Role for sentinel lymph node dissection in the management of large (> or = 5 cm) invasive breast cancer. Ann Surg Oncol. 2001;8:688–92.PubMedGoogle Scholar
  21. 21.
    Andea AA, Bouwman D, Wallis T, Visscher DW. Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentric breast carcinoma. Cancer. 2004;100:20–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Yuen S, Yamada K, Goto M, Sawai K, Nishimura T. CT-based evaluation of axillary sentinel lymph node status in breast cancer: value of added constrast-enhanced study. Acta Radiol. 2004;45:730–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Van der Ploeg IM, Nieweg OE. Axillary recurrence after a tumour-negative sentinel node biopsy in breast cancer patients: a systematic review and meta-analysis of the literature. Eur J Surg Oncol. 2008;34:1277–84.CrossRefPubMedGoogle Scholar
  24. 24.
    Husarik DB, Fehr M, Thuerl CM. Sentinel lymph node scintigraphy in breast cancer: incremental value of SPECT/CT imaging. J Nucl Med. 2005;46:197–8.Google Scholar
  25. 25.
    Gajdos C, Tartter PI, Bleiweiss IJ. Lymphatic invasion, tumor size, and age are independent predictors of axillary lymph node metastases in women with T1 breast cancers. Ann Surg. 1999;230:692–6.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Chadha M, Chabon AB, Friedmann P, Vikram B. Predictors of axillary lymph node metastases in patients with T1 breast cancer. A multivariate analysis. Cancer. 1994;73:350–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Martin RCG, Edwards MJ, Wong SL, Tuttle TM, Carlson DJ, Brown CM, et al. Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. Surgery. 2000;128:139–44.CrossRefPubMedGoogle Scholar

Copyright information

© Korean Society of Nuclear Medicine 2014

Authors and Affiliations

  • Chang Ju Na
    • 1
  • Jeonghun Kim
    • 1
  • Sehun Choi
    • 1
  • Yeon-Hee Han
    • 1
  • Hwan-Jeong Jeong
    • 1
    • 2
  • Myung-Hee Sohn
    • 1
    • 2
  • Hyun Jo Youn
    • 3
  • Seok Tae Lim
    • 1
    • 2
    Email author
  1. 1.Department of Nuclear MedicineChonbuk National University Medical School and HospitalJeonjuRepublic of Korea
  2. 2.Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research CenterChonbuk National University Medical School and HospitalJeonjuRepublic of Korea
  3. 3.Department of SurgeryChonbuk National University Medical School and HospitalJeonjuRepublic of Korea

Personalised recommendations