title: Enhanced sentinel lymphoscintigraphic mapping in breast tumor using the graded shield technique.
abstract: The graded shield technique was developed to increase the sentinel node detection rate by improving lymphoscintigraphic image contrast. In a 6-month period, 50 women with clinical suspicion of early stage breast cancer (T1 and T2 tumors) were enrolled in this study. The patients had a mean age of 47.2 +/- 10.3 years. A composite graded shield was constructed using three concentric layers of leaded plastic measuring 3 cm, 5 cm, and 7 cm each in diameter. The graded shield was designed with a movable Velcro backing for accurate positioning over the injection site. Images were acquired with a vertical angle dual-head gamma camera using an established injection procedure developed at our institution. The rate of detection of sentinel lymph nodes using lymphoscintigraphic mapping improved from 74% (37/50 patients) to 96% (48/50) using the graded shield (p < 0.05). In addition to the increased detection rate, our technique also increased the number of nodes detected and improved visualization of the adjacent lymphatic basin. By enhancing nodal contrast, we have demonstrated that the graded shield technique is an effective method for improving the rate of sentinel node detection.
authors.affiliation: Department of Nuclear Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Chen
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lai
authors.forename: Chien-Chin
authors.initials: CC
authors.lastname: Hsu
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid