Comparison between single photon emission computed tomography with computed tomography and planar scintigraphy in sentinel node biopsy in breast cancer patients

Mitsuru Koizumi,Masamichi Koyama

doi:10.1007/s12149-018-1319-z

Abstract

ObjectiveRadio-guided sentinel node (SN) biopsy is a standard method used in the treatment of early breast cancer. Single photon emission computed tomography with computed tomography (SPECT/CT) has been commonly used for SN detection. SPECT/CT adds precise anatomical information of SN sites, and it is reported that more SNs may be detectable on SPECT/CT than on planar imaging. We here investigate which breast cancer patients have benefited from SPECT/CT over planar imaging.MethodsA total of 273 breast cancer patients including 80 with ipsilateral breast tumor relapse (IBTR) underwent both multiple-view planar imaging and SPECT/CT for SN detection. The number of SNs, the patients who had benefitted from SPECT/CT, and the SN procedure failure rate were compared between SPECT/CT and planar imaging. Factors influencing the visualization of para-sternal and ipsilateral level II, III nodes, and contralateral axillary nodes were also analyzed using logistic regression analysis.ResultsThe number of hot spots did not differ between SPECT/CT and multiple-view planar imaging. Eight contaminated patients and 52 patients with visualized extra-level I axillary nodes benefited from identifying precise anatomical sites. Even though radioactive nodes could be harvested in most (192/193) of the non-IBTR patients (7/8 in non-SN visible patients), no radioactive nodes could be found during surgery in 11 of 80 IBTR patients. Axillary surgery (dissection) increased the visualization of para-sternal and level II, III axillary nodes, and previous irradiation increased the visualization of contralateral axillary nodes.ConclusionMultiple-view planar imaging was equivalent to SPECT/CT for depicting hot nodes for radio-guided SN detection in breast cancer. SPECT/CT was useful when precise anatomical information was necessary, especially regarding sentinel lymph nodes other than ipsilateral axilla. Logistic regression analysis revealed that axillary surgery (dissection) increased the visualization of para-sternal and level II, III axillary nodes, and the only relevant factor influencing visualization of contralateral axillary SNs was previous radiation to the breast.

Highlights

Radio-guided sentinel node (SN) biopsy is a standard method in the treatment of patients with early breast cancer [1,2,3]
SPECT/CT has the advantages of better sensitivity and precise anatomical information, using a hybrid SPECT/CT machine and image fusion technique, over planar scintigraphy [4]
We investigated the factors influencing the visualization of extra-ipsilateral level I axillary nodes and contralateral axillary nodes

Summary

Introduction

Radio-guided sentinel node (SN) biopsy is a standard method in the treatment of patients with early breast cancer [1,2,3]. SPECT/CT has the advantages of better sensitivity and precise anatomical information, using a hybrid SPECT/CT machine and image fusion technique, over planar scintigraphy [4]. No universal method for radio-guided SN detection using a radiocolloid and scintigraphy currently exists [3, 10, 11]. Re-injection of radiocolloid is reportedly more effective than the use of SPECT/CT [12]. We previously reported that taking multi-direction planar images improved the detection of SNs in breast cancer [13]. A method to identify the patients who would benefit from receiving SPECT/CT is needed

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Conclusion