title: The value of imaging in standing position in preoperative breast lymphoscintigraphy.
abstract: OBJECTIVE
  Breast lymphoscintigraphy is an accurate technique, but in a minority of cases the sentinel node (SN) visualization cannot be achieved or can be very difficult. We evaluated the potential clinical advantages and limitations of performing imaging in the standing position. The aim was to establish if this examination modality is quicker and helpful in the presence of "hidden" SN, checking also for any influence of SN skin landmarking in the upright position on the correct intraoperative SN identification. The overall objective was to verify if the standing position can be routinely used in breast lymphoscintigraphy.
  
  
  METHODS
  A total of 144 patients underwent lymphoscintigraphy in both standing and supine positions. In both modalities, a skin landmark was set coincident with the SN orthogonal projections. The acquisition times of 2 groups (each consisting of 45 patients) examined with the standing or supine acquisition modality, were compared.
  
  
  RESULTS
  In 6 cases with hidden SN and in 34 cases with difficult or partial visualization in one of the supine views, the standing protocol was effective and led to better and quicker visualization of lymph nodes (median examination time: 25.5 minutes standing, 35.5 minutes supine). Significant differences in skin landmark position between the 2 modalities were present only in overweight patients and in large breasts. This, however, did not have a negative impact on successful intraoperative localization of SN with the gamma probe.
  
  
  CONCLUSIONS
  Standing acquisition resulted to be a faster, easier, and more accurate examination protocol and can be used as the routine method for SN detection in breast lymphoscintigraphy.
authors.affiliation: Department of Nuclear Medicine, Maggiore della Carità Hospital, Novara, Italy. christos.anagnostou@maggioreosp.novara.it
authors.forename: Christos
authors.initials: C
authors.lastname: Anagnostou
authors.forename: Cinzia
authors.initials: C
authors.lastname: Baiocco
authors.forename: Alberto
authors.initials: A
authors.lastname: Arnulfo
authors.forename: Mauro
authors.initials: M
authors.lastname: Liberatore
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Baccheschi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Inglese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011187:Posture; D057234:Preoperative Period; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D012015:Reference Standards; D013997:Time Factors