Role of SPECT-CT in breast cancer sentinel node biopsy when internal mammary chain drainage is observed.
BACKGROUND
SPECT-CT in the detection of the sentinel lymph node (SLN) of breast cancer offers known advantages over conventional planar lymphoscintigraphy. Sometimes, it shows atypical findings like mediastinal lymphatic drainage. We have evaluated these atypical findings showed by SPECT-CT performed in patients with migration to the internal mammary chain (IMC) and their roles in the management of the patients.


METHODS
We reviewed the 56 lymphoscintigraphies (planar and SPECT-CT) of 56 women (average age: 55 years) diagnosed with breast cancer with IMC migration observed in the planar images. We compared the two techniques, obtaining the number of depicted nodes, atypical locations, their exact anatomical location and their role in the management of the patient.


RESULTS
Planar images showed a total number of 81 IMC nodes. SPECT-CT showed 74 nodes in the IMC territory and 14 mediastinal lymphatic nodes in 6 patients. Out of the 81 IMC nodes reported by planar images, seven corresponded to mediastinal nodes. Planar and hybrid images showed 110 and 130 axillary nodes, respectively. SPECT-CT showed additional findings in five patients: three infraclavicular and two supraclavicular nodes that were exactly located. One intramammary node was discarded by the SPECT-CT as a focal skin contamination.


CONCLUSIONS
Mediastinal nodes are unexpected, but not uncommon findings that are important in the planning of SLN biopsy. SPECT-CT found more nodes than planar images, being able to separate mediastinal and IMC nodes, helping to exactly depict the SLN and its relations with anatomical structures.
Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain. titoserrano@gmail.com.
J
J
Serrano-Vicente
Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain.
J I
JI
Rayo-Madrid
Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain.
M L
ML
Domínguez-Grande
Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain.
J R
JR
Infante-Torre
Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain.
L
L
García-Bernardo
Nuclear Medicine Department, Infanta Cristina Hospital, Elvas Avenue SN, 06080, Badajoz, Spain.
M
M
Moreno-Caballero
Nuclear Medicine Department, Canarias Universitary Hospital, Tenerife, Spain.
F
F
Medina-Romero
Nuclear Medicine Department, Marañón Hospital, Madrid, Spain.
C
C
Durán-Barquero
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D061305:Lymphoscintigraphy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*
Breast cancer; Internal mammary chain; Mediastinum; SPECT-CT; Sentinel node biopsy