SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients With Breast Cancer: A Pilot Study.
OBJECTIVE
The objective of this study was to determine the impact of the use of single-photon emission computed tomography fused with computed tomography (SPECT-CT) on thoracoscopic biopsy of sentinel lymph nodes (SLNs) in the internal mammary chain in patients with breast cancer by evaluating resultant changes in staging and their clinical implications.


METHODS
Between September 2010 and January 2014, we performed lymphoscintigraphy-assisted thoracoscopic biopsy of the internal mammary chain SLN in 20 patients with breast cancer. Single-photon emission computed tomography fused with computed tomography was also used in 13 of these patients. The sentinel nodes were surgically identified with the aid of a gamma probe.


RESULTS
Sentinel lymph nodes were identified surgically in 19 of 20 patients. In the 13 patients in whom SPECT-CT was used, it readily identified SLNs, especially when they were located over an intercostal space. Change of staging occurred in three patients (15%), two of whom accordingly received adjuvant radiotherapy to the internal thoracic chain.


CONCLUSIONS
Compared with lymphoscintigraphy alone, the use of SPECT-CT improves localization of the SLN in the internal mammary chain, allowing more accurate planning of each individual's treatment.
From the *Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; †Instituto do Câncer do Estado de São Paulo (ICESP); and ‡Departamento de Patologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
José Roberto Morales
JR
Piato
José Roberto
JR
Filassi
Alberto Jorge Monteiro
AJ
Dela Vega
George Barberio
GB
Coura-Filho
Fernando Nalesso
FN
Aguiar
Ligia Maria Teixeira Pereira
LM
Porciuncula
Maíra Teixeira
MT
Dória
José Maria
JM
Soares
Edmund Chada
EC
Baracat
D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D061305:Lymphoscintigraphy / Q000379:methods*; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D010865:Pilot Projects; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*