title: The clinical value of hybrid sentinel lymphoscintigraphy to predict metastatic sentinel lymph nodes in breast cancer.
abstract: OBJECTIVE
  Hybrid imaging techniques can provide functional and anatomical information about sentinel lymph nodes in breast cancer. Our aim in this study was to evaluate which imaging parameters on hybrid sentinel lymphoscintigraphy predicted metastatic involvement of sentinel lymph nodes (SLNs) in patients with breast cancer.
  
  
  METHODS
  Among 56 patients who underwent conventional sentinel lymphoscintigraphy, 45 patients (age, 53.1 ± 9.5 years) underwent hybrid sentinel lymphoscintigraphy using a single-photon emission computed tomography (SPECT)/computed tomography (CT) gamma camera. On hybrid SPECT/CT images, we compared the shape and size (long-to-short axis [L/S] ratio) of the SLN, and SLN/periareolar injection site (S/P) count ratio between metastatic and non-metastatic SLNs. Metastatic involvement of sentinel lymph nodes was confirmed by pathological biopsy.
  
  
  RESULTS
  Pathological biopsy revealed that 21 patients (46.7 %) had metastatic SLNs, while 24 (53.3 %) had non-metastatic SLNs. In the 21 patients with metastatic SLNs, the SLN was mostly round (57.1 %) or had an eccentric cortical rim (38.1 %). Of 24 patients with non-metastatic SLNs, 13 patients (54.1 %) had an SLN with a C-shape rim or eccentric cortex. L/S ratio was 2.04 for metastatic SLNs and 2.38 for non-metastatic SLNs. Seven (33 %) patients had T1 primary tumors and 14 (66 %) had T2 primary tumors in the metastatic SLN group. In contrast, 18 (75 %) patients had T1 primary tumors and six (25 %) had T2 tumors in the non-metastatic SLN group. S/P count ratio was significantly lower in the metastatic SLN group than the non-metastatic SLN group for those patients with a T1 primary tumor (p = 0.007).
  
  
  CONCLUSIONS
  Hybrid SPECT/CT offers the physiologic data of SPECT together with the anatomic data of CT in a single image. This hybrid imaging improved the anatomic localization of SLNs in breast cancer patients and predicted the metastatic involvement of SLNs in the subgroup of breast cancer patients with T1 primary tumors.
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Chang Ju
authors.initials: CJ
authors.lastname: Na
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Jeonghun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Sehun
authors.initials: S
authors.lastname: Choi
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Yeon-Hee
authors.initials: YH
authors.lastname: Han
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Hwan-Jeong
authors.initials: HJ
authors.lastname: Jeong
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Myung-Hee
authors.initials: MH
authors.lastname: Sohn
authors.affiliation: Department of Surgery, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Hyun Jo
authors.initials: HJ
authors.lastname: Youn
authors.affiliation: Department of Nuclear Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea ; Department of Nuclear Medicine, Research Institute of Clinical Medicine, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
authors.forename: Seok Tae
authors.initials: ST
authors.lastname: Lim
keywords: Breast cancer; Hybrid sentinel lymphoscintigraphy; Metastatic prediction; Sentinel lymph nodes