Radioguided Surgery for Breast Cancer

Abstract

Sentinel lymph node biopsy is the standard surgical procedure for staging clinically tumor-free regional nodes in patients with early-stage breast cancer. This technique has spared the additional morbidity of axillary lymph node dissection without compromising diagnostic accuracy and prognostic information. However, it is still important to discuss current techniques and some controversies.Current data indicate that the combined radiocolloid injection approach (both superficial and deep injections) results in a higher identification rate of sentinel lymph nodes. Routine preoperative scintigraphic imaging helps the intraoperative search for sentinel lymph nodes and is vital for detecting extra-axillary or aberrant nodes, as well as for patients who have had prior core breast biopsy or surgery. SPECT/CT imaging, in addition to conventional lymphoscintigraphy, leads to improved preoperative visualization and localization of sentinel lymph nodes, especially if performed for specific indications.Complementary intraoperative imaging with portable gamma cameras is being increasingly employed, enhancing the reliability of the gamma probe by adding clear imaging of the surgical fields, especially when the injection site is close to the lymphatic basin. Portable gamma cameras can also be useful during radioguided occult lesion localization procedures in patients with nonpalpable breast lesions. The combined use of radioactive tracers and blue dyes is more effective in detecting sentinel lymph nodes than either modality used alone and is therefore recommended for routine use.Advances in radiopharmaceuticals and computer technology make it possible to integrate optical, hybrid tracers and 3D rendering systems that facilitate intraoperative sentinel lymph node identification.KeywordsBreast cancerSentinel lymph node biopsyNuclear medicineAxillary lymph node dissectionRadiocolloid injectionRadioguided occult lesion localization