The Usefulness of SPECT/CT in Sentinel Node Mapping of Early Stage Breast Cancer Patients Showing Negative or Equivocal Findings on Planar Scintigraphy
Article Type:
Research/Original Article (دارای رتبه معتبر)
Abstract:
Objective(s)
This study sought to determine the diagnostic yield of SPECT/CT in localizing axillary sentinel lymph nodes (SLNs) in early breast cancer patients where planar scintigraphy (PS) was equivocal or negative.
Methods
Prospective analysis of early stage breast cancer patients with nonpalpable axillary nodes undergoing SLN localization prior to nodal sampling for axillary staging. PS findings were categorized as: Category A: non-visualization of SLN; Category B: unusual uptake location; Category C: equivocal uptake / difficult interpretation. The K-coefficient of Cohen was used to evaluate the correlation between PS and SPECT/CT results. PS and SPECT/CT images were interpreted separately, and SLN identification on each of the modalities was correlated to BMI (Body mass index) and peroperative radio guided results.
Results
Between April 2015 and January 2017, 1028 early breast cancer cases underwent sentinel lymphoscintigraphy. Of total, 134 (13%) patients underwent SPECT/CT in addition to PS. All were females with mean age of 48.15 years (range: 26-82 years). Right sided in 68, left in 64 and 2 with bilateral carcinoma. By TNM classification: 49 (37%) T1, 78 (58%) T2 and 7 (5%) had DCIS/Paget’s disease. Overall SLNs were detected on both PS and SPECT/CT in 60% cases. Of category A (n=54); 35/54 (64%) SLN localized on SPECT/CT; 32 were level-I; 2 Level-II; 1 Level-III nodes. In 19, SLN was not localized. Of category B (n=18), 5 had prior lumpectomy, SPECT/CT localized tracer uptake to 17 level-I sentinel nodes, 3 level-II and level III / IMC in 9. Of category C (n=62), 29 had prior lumpectomy. SPECT/CT confirmed SLN in all the cases. Radio-guided surgery confirmed SPECT/CT results. The correlation between the two techniques was low (K=0.34). Where PS was negative; SPECT/ CT localized nodes in statistically significant number of cases (P=0.01). PS identified SLN uptakes in 80/134 (60%) cases with a mean BMI of 21.6±4.8 kg/ m2 while SPECT/CT detected ‘‘hot’’ nodes in 115/134 (86%) cases with a mean BMI of 29.6±5.6 kg/m2. For overweight/obese patients (n=59) (BMI>25 kg/m2), PS failed to identify SLNs in 49 and SPECT/CT failed to do so in 18 (P
Conclusion
SPECT/CT has diagnostic yield and helps in precise SLN localization where planar imaging is negative or shows unusual site of uptake.
Language:
English
Published:
Asia Oceania Journal of Nuclear Medicine & Biology, Volume:6 Issue: 2, Spring 2018
Pages:
80 to 89
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