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Axillary Lymph Node Status Evaluation in Breast Cancer Patients: Role of SPECT and Pinhole SPECT with Cationic Lipophilic Radiotracers

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Abstract

The correct assessment of axillary lymph node status represents the most important goal in the preoperative phase of breast cancer patients since the presence of lymph node metastases together with primary tumor size can be considered, in the absence of distant metastatic localizations, the single most significant parameter to guide the therapeutic strategy and to better determine disease prognosis as well as serving as an indicator of the tumor ability to spread (Carter et al. 1989). In particular, the number of axillary metastatic nodes when it exceeds three is associated with a worse prognosis (Fisher et al. 1983; Carter et al. 1989; Saez et al. 1989). To date, the procedure of choice for pathological axillary status evaluation is represented by axillary lymph node dissection (ALND), which has a routine use in patients with newly ascertained invasive breast cancer in spite of its invasiveness and morbidity. However, ALND may not be necessary in many cases, in particular in early stage carcinomas with tumor size <10 mm and even more so when axillary clinical examination is negative, since in this case the percentage of lymph node metastases is very low. Moreover, even when axillary lymph node metastases are present, ALND may not affect the choice of adjuvant therapy and, apart from this, a change of treatment may give only a small survival benefit. Eventual complications and the costs of the procedure also have to be considered when the indication is equivocal. Thus, at present, the routine use of ALND is questionable.

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  1. Department of Nuclear Medicine, University of Sassari, Sassari, Italy

    Giuseppe Madeddu & Angela Spanu

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  1. Giuseppe Madeddu
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  1. Division of Nuclear Medicine Department of Diagnostic Imaging and Radiotherapy Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy

    Emilio Bombardieri MD

  2. Division of Medical Oncology Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy

    Luca Gianni MD

  3. Perspective Clinical Trials Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milano, Italy

    Gianni Bonadonna MD (Chair) (Chair)

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Madeddu, G., Spanu, A. (2008). Axillary Lymph Node Status Evaluation in Breast Cancer Patients: Role of SPECT and Pinhole SPECT with Cationic Lipophilic Radiotracers. In: Bombardieri, E., Gianni, L., Bonadonna, G. (eds) Breast Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-36781-9_5

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