title: Improved sentinel node identification by SPECT/CT in overweight patients with breast cancer.
abstract: Overweight has been reported as a cause for the nonvisualization of sentinel nodes (SNs) on preoperative planar lymphoscintigraphy in patients with breast cancer. The purpose of this study was to assess whether SPECT/CT may improve SN identification in overweight patients.
  
  
  METHODS
  Lymphoscintigraphy was performed in 220 consecutive patients with breast cancer. Body mass index (BMI) was calculated for each. A total of 122 patients were overweight or obese (BMI, > or = 25). Planar images and SPECT/CT images were interpreted separately, and SN identification on each of the modalities was related to BMI and to findings at surgery.
  
  
  RESULTS
  Planar imaging identified SNs in 171 patients (78%) with a BMI (mean +/- SD) of 25.2 +/- 4 kg/m2 and failed to do so in 49 patients (22%) with a BMI of 28 +/- 8 kg/m2. In 29 of the latter patients (59%), SNs were identified on SPECT/CT. SPECT/CT detected "hot" nodes in 200 patients (91%) and failed to do so in 20 patients with a BMI of 29.2 +/- 6.6 kg/m2. For the 122 overweight or obese patients, planar assessment failed to identify SNs in 34 patients (28%) and SPECT/CT failed to do so in 13 patients (11%) (P < 0.001). For 116 patients, surgery took place in our hospital (Tel-Aviv Sourasky Medical Center). An intraoperative blue dye technique failed to detect SNs in 48 patients (41%) with a BMI of 28.2 +/- 7 kg/m2. SPECT/CT localized hot nodes in 36 (75%) of the latter patients, and planar imaging did so in 22 (46%) of those patients. Of 19 patients for whom scintigraphy failed, 6 (32%) had nodal metastatic involvement.
  
  
  CONCLUSIONS
  The addition of SPECT/CT to lymphoscintigraphy improved SN identification in overweight patients with breast cancer. Moreover, SPECT/CT accurately identified SNs in 75% of patients for whom the identification of SNs by the intraoperative blue dye technique failed.
authors.affiliation: Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. hedval@tasmc.health.gov.il
authors.forename: Hedva
authors.initials: H
authors.lastname: Lerman
authors.forename: Gennady
authors.initials: G
authors.lastname: Lievshitz
authors.forename: Osnat
authors.initials: O
authors.lastname: Zak
authors.forename: Ur
authors.initials: U
authors.lastname: Metser
authors.forename: Shlomo
authors.initials: S
authors.lastname: Schneebaum
authors.forename: Einat
authors.initials: E
authors.lastname: Even-Sapir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed