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Role of SPECT-CT in breast cancer sentinel node biopsy when internal mammary chain drainage is observed

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Abstract

Introduction

SPECT-CT in the detection of the sentinel lymph node (SLN) of breast cancer offers known advantages over conventional planar lymphoscintigraphy. Sometimes, it shows atypical findings like mediastinal lymphatic drainage. We have evaluated these atypical findings showed by SPECT-CT performed in patients with migration to the internal mammary chain (IMC) and their roles in the management of the patients.

Materials and methods

We reviewed the 56 lymphoscintigraphies (planar and SPECT-CT) of 56 women (average age: 55 years) diagnosed with breast cancer with IMC migration observed in the planar images. We compared the two techniques, obtaining the number of depicted nodes, atypical locations, their exact anatomical location and their role in the management of the patient.

Results

Planar images showed a total number of 81 IMC nodes. SPECT-CT showed 74 nodes in the IMC territory and 14 mediastinal lymphatic nodes in 6 patients. Out of the 81 IMC nodes reported by planar images, seven corresponded to mediastinal nodes. Planar and hybrid images showed 110 and 130 axillary nodes, respectively. SPECT-CT showed additional findings in five patients: three infraclavicular and two supraclavicular nodes that were exactly located. One intramammary node was discarded by the SPECT-CT as a focal skin contamination.

Conclusion

Mediastinal nodes are unexpected, but not uncommon findings that are important in the planning of SLN biopsy. SPECT-CT found more nodes than planar images, being able to separate mediastinal and IMC nodes, helping to exactly depict the SLN and its relations with anatomical structures.

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Authors and Affiliations

  1. Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain

    J. Serrano-Vicente, J. I. Rayo-Madrid, M. L. Domínguez-Grande, J. R. Infante-Torre, L. García-Bernardo & M. Moreno-Caballero

  2. Nuclear Medicine Department, Canarias Universitary Hospital, Tenerife, Spain

    F. Medina-Romero

  3. Nuclear Medicine Department, Marañón Hospital, Madrid, Spain

    C. Durán-Barquero

Authors
  1. J. Serrano-Vicente
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  2. J. I. Rayo-Madrid
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  3. M. L. Domínguez-Grande
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  4. J. R. Infante-Torre
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  5. L. García-Bernardo
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  6. M. Moreno-Caballero
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  7. F. Medina-Romero
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  8. C. Durán-Barquero
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Corresponding author

Correspondence to J. Serrano-Vicente.

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Conflict of interest

There are no potential conflicts of interest to disclose or of funding received for the work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Serrano-Vicente, J., Rayo-Madrid, J.I., Domínguez-Grande, M.L. et al. Role of SPECT-CT in breast cancer sentinel node biopsy when internal mammary chain drainage is observed. Clin Transl Oncol 18, 418–425 (2016). https://doi.org/10.1007/s12094-015-1384-x

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  • DOI: https://doi.org/10.1007/s12094-015-1384-x

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