Potential advantage of preoperative three-dimensional mapping of sentinel nodes in breast cancer by a hybrid single photon emission CT (SPECT)/CT system

Ibusuki, Mutsuko; Yamamoto, Yutaka; Kawasoe, Teru; Shiraishi, Shinya; Tomiguchi, Seiji; Yamashita, Yasuyuki; Honda, Yumi; Iyama, Kenichi; Iwase, Hirotaka

doi:10.1016/j.suronc.2009.04.001

« Previous Next »Surgical Oncology
Volume 19, Issue 2 , Pages 88-94, June 2010

Potential advantage of preoperative three-dimensional mapping of sentinel nodes in breast cancer by a hybrid single photon emission CT (SPECT)/CT system

Mutsuko Ibusuki
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Yutaka Yamamoto
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
- Corresponding author. Tel.: +81 96 373 5521; fax: +81 96 373 5525.
Teru Kawasoe
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Seiji Tomiguchi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Yumi Honda
- Department of Surgical Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Kenichi Iyama
- Department of Surgical Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan
Hirotaka Iwase
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo Kumamoto, Kumamoto 860-8556, Japan

Accepted 1 April 2009.

Abstract

Objective

This study aims to assess the role of three-dimensional single-photon emission computed tomography (3D-SPECT/CT) in sentinel node (SN) identification, and to analyze the impact of such information on estimating metastases to SNs.

Background

Nodal status is a key factor for breast cancer. SN biopsy has been established as the alternative to routine axillary dissection these days. We investigated both the anatomical location of SNs demonstrated by our 3D-SPECT/CT system and the correlation to SN positivity.

Methods

Two hundred and twenty-three clinically node-negative patients underwent SN biopsy. All of the axillary structures, including SNs, were visualized by a SPECT/CT combined system after subcutaneous injection of ^99mTc-phytate. By plotting the visualized SNs, the most frequent SN location ‘Pedestal area (PA)’ was designated.

Results

SPECT/CT detected ^99mTc uptake in 217 cases (97.3%). 3D-SPECT/CT images visualized the accurate location of SNs in each case. In patients whose SNs were histopathologically negative (SN−), 228 (98.3%) SNs were found in the PA, and 4 (1.7%) were in other zones. In those with histopathologically positive SNs (SN+), 65 (78.3%) SNs were in the PA and 18 (21.7%) were outside it. The difference in SN distribution (i.e., in or out of the PA) between SN+ and SN− patients was statistically significant (p<0.001, chi-square test).

Conclusions

SN biopsy navigated by 3D-SPECT/CT can clarify the preoperative anatomical localization of SNs in patients with breast cancer. Atypical distribution of SNs out of the PA may suggest SN positivity, reflecting failure of the lymphatic drainage systems.

Keywords: Sentinel Node Mapping, Breast cancer, 3D-SPECT/CT, Metastases