[SPECT-CT: a new tool for localisation of sentinel lymph nodes in breast cancer patients].
BACKGROUND
Sentinel lymph node biopsy has become a widely accepted procedure for axillary lymph node staging in patients with breast cancer.


OBJECTIVE
The aim of this study was to determine the advantages of using SPECT-CT instead of planar scintigraphy in the presurgical localisation of sentinel lymph nodes.


METHODS
We prospectively included 25 consecutive patients with breast cancer who were admitted to our department for SLN localisation. Patients were divided into two groups, depending on whether neoadjuvant chemotherapy had been received (B, n = 6) or not (A, n = 19). Four doses (1.0 mCi each) of 99mTc-nanocolloid were injected intradermallly in all patients, and SPECT-CT and planar images were acquired. All patients underwent surgery and SLN localisation with a hand-held gamma probe. Any axillary "hot spots" were resected. The kappa index (ki) was calculated using surgical findings as the gold standard.


RESULTS
In group A, the SLN was correctly detected in 17/19 patients (89.5 %) with SPECT-CT and in 12/19 (63.2 %) with planar images. The correlation between SPECT-CT and surgical findings (ki 0.91) was better than between planar images and surgical findings (ki 0.57). In group B, the results of SPECT-CT and planar images were identical, with accurate localisation of the SLN in 5/6 patients (ki 0.76).


CONCLUSIONS
The results of this study suggest that SPECT-CT may be useful for locating the SLN in breast cancer patients, as it provides accurate localization of the SLN with useful anatomical information. This may allow the surgeon to search exclusively for SLN viewed on SPECT-CT, and avoid false negative and false positive results.
Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, España. jorgemuci@vodafone.es
J
J
Mucientes Rasilla
L
L
Farge Balbín
J
J
Cardona Arboniés
A
A
Moreno Elola-Olaso
R
R
Delgado-Bolton
L
L
Izarduy Pereyra
C
C
Rodríguez Rey
L
L
Lapeña Gutiérrez
A
A
González Maté
J M
JM
Román Santamaría
J L
JL
Carreras Delgado
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid