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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Koolen BB, Vrancken Peeters MJTFD, Aukema TS, et al. 18F-FDG PET/CT as staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques. Breast Cancer Res Treat. 2012;131:117–26.CrossRefPubMedGoogle Scholar
Groheux D, Giacchetti S, Espie M, et al. Early monitoring of response to neoadjuvant chemotherapy in breast cancer with 18F-FDG PET/CT: defining a clinical aim. Eur J Nucl Med Mol Imaging. 2011;38:419–25.CrossRefPubMedGoogle Scholar
Pace L, Nicolai E, Luongo A, et al. Comparison of whole body PET/CT and PET/MRI in breast cancer patients: lesion detection and quatitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues. Eur J Radiol. 2014;83:289–96.CrossRefPubMedGoogle Scholar
Hoefnagel CA, Sivro-Prndelj F, Valdés Olmos RA. Lymphoscintigraphy and sentinel node procedures in breast carcinoma: role, techniques and safety aspects. World J Nucl Med. 2002;1:45–54.Google Scholar
McNeill G, Witte M, Witte C, et al. Whole-body lymphoscintigraphy: preferred method for initial assessment of the peripheral lymphatic system. Radiology. 1989;172:495–502.CrossRefPubMedGoogle Scholar
Vaqueiro M, Gloviczki P, Fisher J, et al. Lymphoscintigraphy in lymphedema: aid to microsurgery. J Nucl Med. 1986;27:1125–30.PubMedGoogle Scholar
Perre CI, Hoefnagel CA, Kroon BBR, et al. Altered lymphatic drainage after lymphadenectomy or radiotherapy of the axilla in breast cancer patients: a lymphoscintigraphic study. Br J Surg. 1996;83:1258.CrossRefPubMedGoogle Scholar
Ege GN. Internal mammary lymphoscintigraphy: a rational adjunct to the staging and management of breast carcinoma. Clin Radiol. 1978;29:453–6.CrossRefPubMedGoogle Scholar
Hoefnagel CA, Bartelink H, Heidendal Jeune M, Marcuse HR. Internal mammary lymphoscintigraphy for radiation therapy planning in breast carcinoma. J Eur Radiother. 1982;3:35–42.Google Scholar
Ege GN, Elhakim T. The relevance of internal mammary lymphoscintigraphy in the management of breast carcinoma. J Clin Oncol. 1984;7:774–81.CrossRefGoogle Scholar
Bourgeois P, Frühling J. Lymphoscintigraphy in adult malignancy. In: Murray IPC, Ell PJ, editors. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. Edinburgh: Churchill Livingstone; 1998. p. 783–90.Google Scholar
Nieweg OE, Valdés Olmos RA, Jansen L, et al. Cutaneous lymphoscintigraphy. In: Nieweg E, Reintgen T, editors. Lymphatic mapping and probe applications in cancer. New York: Marcel Dekker; 2000. p. 43–70.Google Scholar
Rutgers EJT, Muller SH, Hoefnagel CA. The use of intraoperative probes in surgical oncology. In: Murray IPC, Ell PJ, editors. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. London: Churchill Livingstone; 1998. p. 1025–36.Google Scholar
Van Diest PJ, Peterse HJ, Borgstein PJ, et al. Pathological investigation of sentinel lymph nodes. Eur J Nucl Med. 1999;26(suppl):S43–9.CrossRefPubMedGoogle Scholar
Chatterjee S, Menon M, Drew PJ, et al. Sentinel node biopsy in primary breast cancer: a prospective assessment of two complementary techniques. Eur J Surg Oncol. 1998;24:615–6.Google Scholar
Van de Ent FWC, Kengen RAM, Van der Poll HAG, Hoofwijk AGM. Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer. Eur J Surg Oncol. 1999;25:24–9.CrossRefPubMedGoogle Scholar
Uren RF, Hoefnagel CA. Lymphoscintigraphy. In: Thompson JF, Morton DL, Kroon BBR, editors. Melanoma. London: Martin Dunitz; 2004. p. 339–64.Google Scholar
Alazraki NP, Grant S, Styblo T, et al. Peritumoral (PT) vs subdermal (SD) injection methods for sentinel lymph node (SLN) imaging and intraoperative localization using 2 filtration sizes. J Nucl Med. 2000;41:71. (abstr)Google Scholar
Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients. Br J Cancer. 2002;87:705–10.CrossRefPubMedPubMedCentralGoogle Scholar
Valdés Olmos RA, Jansen L, Hoefnagel CA, et al. Evaluation of mammary lymphoscintigraphy by single intratumoral injection for sentinel node identification. J Nucl Med. 2000;41:1500–6.PubMedGoogle Scholar
Valdés Olmos RA, Tanis PJ, Hoefnagel CA, et al. Improved sentinel node visualization in breast cancer by optimizing the colloid particle concentration and tracer dose. Nucl Med Commun. 2001;22:579–86.CrossRefPubMedGoogle Scholar
Tanis PJ, Deurloo EE, Valdés Olmos RA, et al. Single intralesional tracer dose for radioguided excision of clinically occult breast cancer and sentinel node. Ann Surg Oncol. 2001;8:850–5.CrossRefPubMedGoogle Scholar
Feggi L, Basaglia E, Corcione S, et al. An original approach in the diagnosis of early breast cancer: use of the same radiopharmaceutical for both non-palpable lesions and sentinel node localisation. Eur J Nucl Med. 2001;28:1589–96.CrossRefPubMedGoogle Scholar
Luini A, Zurrida S, Paganelli G, et al. Comparison of radioguided excision with wire localization in occult breast lesion. Br J Surg. 1999;86:522–5.CrossRefPubMedGoogle Scholar
Veit-Haibach P, Beyer T. State-of-the-art SPECT/CT: technology, methodology and applications. Eur J Nucl Med Mol Imaging. 2014;41(Suppl 1):S1–S149.PubMedGoogle Scholar
Van der Ploeg IMC, Valdes Olmos RA, Nieweg OE, et al. The additional value of SPECT/CT in lymphatic mapping in breast cancer and melanoma. J Nucl Med. 2007;48:1756–60.CrossRefPubMedGoogle Scholar
Reintgen D, Albertini J, Milliotes G, et al. Investment in new technology research can save future health care dollars. J Fla Med Assoc. 1997;84:175–81.PubMedGoogle Scholar
Gemignani ML, Cody HS 3rd, Fey JV, et al. Impact of sentinel lymph node mapping on relative charges in patients with early-stage breast cancer. Ann Surg Oncol. 2000;7:575–80.CrossRefPubMedGoogle Scholar
Jansen L, Muller SH, Nieweg OE, et al Uptake of radiocolloid in sentinel lymph nodes. In: Jansen L. Sentinel Node Biopsy, evolving from melanoma to breast cancer, Thesis, University of Amsterdam 1999. pp 151–168.Google Scholar
Miner TJ, Shriver CD, Flicek PR, et al. Guidelines for the safe use of radioactive materials during localization and resection of the sentinel lymph node. Ann Surg Oncol. 1999;6:75–82.CrossRefPubMedGoogle Scholar
Persijn K, de Geest E. Sentinel node method: radiological protection. Tijdschr Nucl Geneesk. 2000;20:62. (abstract)Google Scholar