title: Contribution of SPECT/CT for sentinel node localization in patients with ipsilateral breast cancer relapse.
abstract: BACKGROUND
  In recent years repeat sentinel node (SN) biopsy has been proven to be feasible in local breast cancer recurrence (LBCR). However, in these patients SNs outside the ipsilateral axilla are frequently observed. This study evaluates the contribution of SPECT/CT for SN localization and surgical adjustment in LBCR patients.
  
  
  METHODS
  SN biopsy was performed in 122 LBCR patients (median age 60.5 years, range 24-87), enrolled from August 2006 to July 2015. Median disease-free time lapse was 109.5 months (range 9-365). Axillary lymph node dissection (ALND) had previously been performed in 55 patients, SN biopsy in 44, both techniques in 13 and fine-needle aspiration in 10. Primary breast cancer treatment included radiotherapy in 104 patients (85.3 %) and chemotherapy in 40 (32.8 %). Preoperative lymphatic mapping, using planar scintigraphy (PS) and SPECT/CT included report of SN location according to lymph node territory. In case of a territorial PS-SPECT/CT mismatch, surgery was adjusted according to SPECT/CT findings.
  
  
  RESULTS
  SPECT/CT SN visualization rate was higher than PS (53.3 % vs. 43.4 %, p n.s.) with, in total, 19 additional SN (118 vs. 99, p n.s.). PS-SPECT/CT territory mismatch, found in 60 % (39/65) of patients with SN visualization, led to surgical adjustment in 21.3 % (26/122) of patients. The SN procedure was finally performed in 104 patients resulting in a 65.7 % surgical retrieval rate with a total of 132 removed SNs (1.86/patient). SN metastases were found in 17/71 patients (23.9 %), in 16 of them (94 %) in ipsilateral basins outside the axilla or in the contralateral axilla.
  
  
  CONCLUSIONS
  Using SPECT/CT there is a trend to visualize more SNs in LBCR, providing at the same time important anatomical information to adjust intraoperative SN procedures. The addition of SPECT/CT to the standard imaging protocol may lead to better staging mainly in patients presenting drainage outside the ipsilateral axilla.
authors: Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.|Nuclear Medicine, Medical Imaging Clinical Area, Hospital La Fe, Valencia, Spain.
authors: Pablo
authors: P
authors: Borrelli
authors: Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors: Maarten L
authors: ML
authors: Donswijk
authors: Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors: Marcel P
authors: MP
authors: Stokkel
authors: Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors: Suzana C
authors: SC
authors: Teixeira
authors: Department of Biometrics, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Harm
authors: H
authors: van Tinteren
authors: Department of Surgery, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Emiel J Th
authors: EJ
authors: Rutgers
authors: Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. r.valdes@nki.nl.|Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands. r.valdes@nki.nl.
authors: Renato A
authors: RA
authors: Valdés Olmos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D061305:Lymphoscintigraphy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy; D000072098:Single Photon Emission Computed Tomography Computed Tomography
keywords: Lymphoscintigraphy; Radioguided surgery; Recurrent breast cancer; SPECT/CT; Sentinel node