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Sciallis A. Intraoperative evaluation of sentinel lymph nodes in patients with breast cancer: A review emphasizing clinical concepts pathologists need to know. Semin Diagn Pathol 2024:S0740-2570(24)00064-9. [PMID: 38937191 DOI: 10.1053/j.semdp.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Andrew Sciallis
- Staff Pathologist, Pathology and Laboratory Medicine Institute (PLMI), Cleveland Clinic, Cleveland, OH 44195, United States.
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Sentinel lymph node biopsy in breast cancer after neoadjuvant therapy using a magnetic tracer versus standard technique: A multicentre comparative non-inferiority study (IMAGINE-II). INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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False-negative frozen section of sentinel nodes in early breast cancer (cT1-2N0) patients. World J Surg Oncol 2021; 19:183. [PMID: 34158071 PMCID: PMC8220681 DOI: 10.1186/s12957-021-02288-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) is the standard approach for the axillary region in early breast cancer patients with clinically negative nodes. The present study investigated patients with false-negative sentinel nodes in intraoperative frozen sections (FNSN) using real-world data. Methods A case–control study with a 1:3 ratio was conducted. FNSN was determined when sentinel nodes (SNs) were negative in frozen sections but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) sections. The control was defined as having no metastasis of SNs in both frozen and FFPE sections. Results A total of 20 FNSN cases and 60 matched controls from 333 SLNB patients were enrolled between April 1, 2005, and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between the FNSN and control groups. The FNSN patients had larger tumor sizes on preoperative mammography (P = 0.033) and more lymphatic tumor emboli on core biopsy (P < 0.001). Four FNSN patients had metastasis in nonrelevant SNs. Another 16 FNSN patients had benign lymphoid hyperplasia of SNs in frozen sections and metastasis in the same SNs from FFPE sections. Micrometastasis was detected in seven of 16 patients, and metastases in nonrelevant SNs were recognized in two patients. All FNSN patients underwent a second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed breast cancer recurrence. The disease-free survival, breast cancer-specific survival, and overall survival in FNSN were not inferior to those in controls. Conclusions Patients with a larger tumor size and more lymphatic tumor emboli have a higher incidence of FNSN. However, the outcomes of FNSN patients after completing ALND were noninferior to those without SN metastasis. ALND provides a correct staging for patients with metastasis in nonsentinel axillary lymph nodes.
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Accuracy of breast MRI in evaluating nodal status after neoadjuvant therapy in invasive lobular carcinoma. NPJ Breast Cancer 2021; 7:25. [PMID: 33674614 PMCID: PMC7935955 DOI: 10.1038/s41523-021-00233-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023] Open
Abstract
Neoadjuvant therapy in breast cancer can downstage axillary lymph nodes and reduce extent of axillary surgery. As such, accurate determination of nodal status after neoadjuvant therapy and before surgery impacts surgical management. There are scarce data on the diagnostic accuracy of breast magnetic resonance imaging (MRI) for nodal evaluation after neoadjuvant therapy in patients with invasive lobular carcinoma (ILC), a diffusely growing tumor type. We retrospectively analyzed patients with stage 1–3 ILC who underwent pre-operative breast MRI after either neoadjuvant chemotherapy or endocrine therapy at our institution between 2006 and 2019. Two breast radiologists reviewed MRIs and evaluated axillary nodes for suspicious features. All patients underwent either sentinel node biopsy or axillary dissection. We evaluated sensitivity, specificity, negative and positive predictive values, and overall accuracy of the post-treatment breast MRI in predicting pathologic nodal status. Of 79 patients, 58.2% received neoadjuvant chemotherapy and 41.8% neoadjuvant endocrine therapy. The sensitivity and negative predictive value of MRI were significantly higher in the neoadjuvant endocrine therapy cohort than in the neoadjuvant chemotherapy cohort (66.7 vs. 37.9%, p = 0.012 and 70.6 vs. 40%, p = 0.007, respectively), while overall accuracy was similar. Upstaging from clinically node negative to pathologically node positive occurred in 28.0 and 41.7%, respectively. In clinically node positive patients, those with an abnormal post-treatment MRI had a significantly higher proportion of patients with ≥4 positive nodes on pathology compared to those with a normal MRI (61.1 versus 16.7%, p = 0.034). Overall, accuracy of breast MRI for predicting nodal status after neoadjuvant therapy in ILC was low in both chemotherapy and endocrine therapy cohorts. However, post-treatment breast MRI may help identify patients with a high burden of nodal disease (≥4 positive nodes), which could impact pre-operative systemic therapy decisions. Further studies are needed to assess other imaging modalities to evaluate for nodal disease following neoadjuvant therapy and to improve clinical staging in patients with ILC.
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Sun X, Zhang Q, Niu L, Huang T, Wang Y, Zhang S. Establishing a prediction model of axillary nodal burden based on the combination of CT and ultrasound findings and the clinicopathological features in patients with early-stage breast cancer. Gland Surg 2021; 10:751-760. [PMID: 33708557 DOI: 10.21037/gs-20-899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Axillary lymph node (ALN) management in early-stage breast cancer (ESBC) patients has become less invasive during the past decades. Here, we tried to explore whether high nodal burden (HNB) in ESBC patients could be predicted preoperatively, so as to avoid unnecessary sentinel lymph node biopsy (SLNB). Methods The clinicopathological and imaging data of patients with early invasive breast cancer (cT1-2N0M0) were analyzed retrospectively. Univariate and multivariate analyses were performed for the risk factors of axillary HNB in ESBC patients, and a risk prediction model of HNB was established. Results HNB was identified in 105 (8.0%) of 1,300 ESBC patients. Multivariate analysis showed that estrogen receptors (ER) status, human epidermal growth factor receptor 2 (HER2) status, number of abnormal lymph nodes (LNs) on computed tomography (CT), and axillary score on ultrasound (US) were the risk factors of HNB (all P<0.05). The area under the receiver operating characteristic (ROC) curve in the prediction model was 0.914, with the sensitivity being 85.7% and the specificity being 82.4%. The calibration curve showed that the prediction model had good performance. Conclusions As a valuable tool for predicting HNB in ESBC patients, this newly established model helps clinicians to make reasonable axillary surgery decisions and thus avoid unnecessary SLNB.
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Affiliation(s)
- Xianfu Sun
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qiang Zhang
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Lianjie Niu
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Tao Huang
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yingjie Wang
- Department of Oncology, Affiliated Zhengzhou Cancer Hospital of Henan University, Zhengzhou Cancer Hospital, Zhengzhou, China
| | - Shengze Zhang
- Department of Thyroid and Breast III, Cangzhou Central Hospital, Cangzhou, China
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Evaluating the impact of axillary dissection on recurrence-free survival by extent of nodal disease in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2020; 183:661-667. [PMID: 32696313 DOI: 10.1007/s10549-020-05794-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Clinical trials have shown that axillary lymph node dissection (ALND) can be avoided for many breast cancer patients with limited nodal involvement. However, whether its omission is safe for those with invasive lobular carcinoma (ILC) is still questioned. We sought to evaluate the impact of ALND on recurrence-free survival (RFS) by extent of nodal disease in patients with ILC. METHODS We performed a retrospective, cross-sectional analysis of ILC patients treated between 1990 and 2019 at our institution. Patients underwent either breast conservation surgery (BCS) or mastectomy. We used univariate and multivariate statistics in Stata 14.2 to evaluate associations between extent of axillary surgery and time to recurrence stratified by nodal burden. RESULTS Of 520 cases, 387 (78.4%) were node negative, 74 (14.9%) had 1-2 positive nodes, and 59 (11.4%) had three or more positive nodes. Most patients (93.3%) had hormone receptor-positive disease, and 94.8% had low or intermediate-grade tumors. The rate of ALND significantly decreased over time (p < 0.002). Using a multivariate model, there was no significant difference in RFS estimates based on receipt of ALND (HR = 0.53, 95% CI 0.17-1.64, p = 0.27), which also held true for patients with 1-2 positive nodes using a test of interaction (HR = 0.91, 95% CI 0.12-6.76, p = 0.92). CONCLUSIONS These findings support the safety of omitting ALND in selected patients with ILC. Further studies of axillary management in ILC and imaging tools to predict nodal involvement and therapeutic response are warranted.
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Nguyen L, Khazai L, Hakam A, Centeno BA, Rosa M. Diagnostic value of intraoperative rapid cytokeratin immunostain in the cytological evaluation of sentinel lymph nodes in patients with invasive lobular carcinoma. Diagn Cytopathol 2018; 47:482-487. [PMID: 30589516 DOI: 10.1002/dc.24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/26/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is the standard of practice in clinically node-negative patients with breast carcinoma. Intraoperative imprint cytology (IC) is often used in this setting. In cases of invasive lobular carcinoma (ILC), interpretation of IC slides may be challenging. Rapid cytokeratin immunohistochemistry (R-CK) has been used in this scenario. This study evaluated if the combination of IC and R-CK improves the sensitivity of intraoperative SLN evaluation of ILC in our setting. METHODS SLN of all cases of ILC in which IC and R-CK were performed in a 4 year period were included. Final tissue diagnosis was used as the gold standard. RESULTS Four hundred and twenty-seven of the 802 IC performed during the study period corresponded to paired IC and R-CK for ILC. Independently, IC and R-CK correctly classified the SLN as negative or positive in 355 cases (83%) and 324 (76%) cases, respectively. In combination, IC and R-CK correctly classified 304 (71%) of cases. R-CK failed in 56 cases. R-CK aided in rendering an accurate diagnosis in 59% of atypical cases (19/32). Patients with atypical IC and positive R-CK did not undergo axillary dissection. The addition of R-CK increased the turnaround time (TAT) by 24 minutes. CONCLUSIONS In this study, the addition of R-CK did not improve the diagnostic accuracy in cases classified as negative or positive by IC, but resulted in a considerable increase in TAT. Although R-CK proved to be of diagnostic value in atypical IC cases, it did not appear to influence clinical management.
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Affiliation(s)
- Lynh Nguyen
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fl 33612, USA
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fl 33612, USA
| | - Ardeshir Hakam
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fl 33612, USA
| | - Barbara A Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fl 33612, USA
| | - Marilin Rosa
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fl 33612, USA
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Harrison BT, Brock JE. Contemporary Evaluation of Breast Lymph Nodes in Anatomic Pathology. Am J Clin Pathol 2018; 150:4-17. [PMID: 29746624 DOI: 10.1093/ajcp/aqy024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Management of the axilla in breast cancer patients has evolved considerably since the introduction of the sentinel lymph node (SLN) biopsy in the 1990s. Several new clinical and technological developments in the last decade warrant special consideration due to their impact on pathology practice. METHODS This review covers the SLN biopsy procedure, issues in the histopathologic and molecular diagnosis of the SLN, and most importantly, evidence from recent practice-changing clinical trials. RESULTS ACOSOG Z0011, IBCSG 23-01, and AMAROS trials have shown that early-stage breast cancer patients who have limited metastatic involvement of the SLNs do not benefit from completion axillary dissections. CONCLUSIONS It is not necessary for pathologists to search for all small metastases to predict non-SLN involvement, regional recurrence, or death due to disease. Processing should be designed with the goal of detecting macrometastases. Multiple levels, routine immunohistochemistry, and molecular testing are not recommended.
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Affiliation(s)
- Beth T Harrison
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Jane E Brock
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
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Abstract
CONTEXT -Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes. OBJECTIVE -To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes. DATA SOURCES -Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. CONCLUSIONS -The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin-stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non-sentinel lymph node involvement. This information is important to decide on further axillary treatment.
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Affiliation(s)
| | - Edi Brogi
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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Andreis D, Bonardi S, Allevi G, Aguggini S, Gussago F, Milani M, Strina C, Spada D, Ferrero G, Ungari M, Rocca A, Nanni O, Roviello G, Berruti A, Harris AL, Fox SB, Roviello F, Polom K, Bottini A, Generali D. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with T2 to T4, N0 and N1 breast cancer. Breast 2016; 29:55-61. [PMID: 27428471 DOI: 10.1016/j.breast.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Histological status of axillary lymph nodes is an important prognostic factor in patients receiving surgery for breast cancer (BC). Sentinel lymph node (SLN) biopsy (B) has rapidly replaced axillary lymph node dissection (ALND), and is now the standard of care for axillary staging in patients with clinically node-negative (N0) operable BC. The aim of this study is to compare pretreatment lymphoscintigraphy with a post primary systemic treatment (PST) scan in order to reduce the false-negative rates for SLNB. METHODS In this single-institution study we considered 170 consecutive T2-4 N0-1 M0 BC patients treated with anthracycline-based PST. At the time of incisional biopsy, we performed sentinel lymphatic mapping. After PST, all patients repeated lymphoscintigraphy with the same methodology. During definitive surgery we performed further sentinel lymphatic mapping, SLNB and ALND. RESULTS The SLN was removed in 158/170 patients giving an identification rate of 92.9% (95% confidence interval (CI) = 88.0-96.3%) and a false-negative rate of 14.0% (95% CI = 6.3-25.8%). SLNB revealed a sensitivity of 86.0% (95% CI = 74.2-93.7%), an accuracy of 94.9% (95% CI = 90.3-97.8%) and a negative predictive value of 92.7% (95% CI = 86.1-96.8%). CONCLUSION Identification rate, sensitivity and accuracy are in accordance with other studies on SLNB after PST, even after clinically negative node conversion following PST. This study confirms that diagnostic biopsy and neoadjuvant chemotherapy maintain breast lymphatic drainage unaltered.
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Affiliation(s)
- D Andreis
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - S Bonardi
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - G Allevi
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - S Aguggini
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - F Gussago
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - M Milani
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - C Strina
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - D Spada
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - G Ferrero
- U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - M Ungari
- U.O. di Anatomia Patologica, Azienda Istituti Ospitalieri di Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - A Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - O Nanni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - G Roviello
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Section of Pharmacology and University Center DIFF - Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25124 Brescia, Italy
| | - A Berruti
- Oncologia Medica, Spedali Civili di Brescia, Università di Brescia, Italy
| | - A L Harris
- Weatherall Molecular Oncology Laboratories, Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, OX3 9DS Oxford, UK
| | - S B Fox
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia
| | - F Roviello
- Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy
| | - K Polom
- Department of Medical, Surgical and Neuroscience, Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci 11, 53100 Siena, Italy
| | - A Bottini
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy
| | - D Generali
- U.O. Chirurgia Generale ad Indirizzo Senologico, S.S. Terapia Molecolare e Farmacogenomica - Dipartimento di Chirurgia, Azienda Ospedaliera Istituti Ospitalieri, 26100 Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129 Trieste, Italy.
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Zhou W, Zhao Y, Pan H, Li Q, Li X, Chen L, Zha X, Ding Q, Wang C, Liu X, Wang S. Great tumour burden in the axilla may influence lymphatic drainage in breast cancer patients. Breast Cancer Res Treat 2016; 157:503-10. [DOI: 10.1007/s10549-016-3831-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
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Freesmeyer M, Winkens T, Opfermann T, Elsner P, Runnebaum I, Darr A. Real-time ultrasound and freehand-SPECT. Experiences with sentinel lymph node mapping. Nuklearmedizin 2014; 53:259-64. [PMID: 25056555 DOI: 10.3413/nukmed-0680-14-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 07/20/2014] [Indexed: 11/20/2022]
Abstract
UNLABELLED Aim of this work is to report first experiences of the feasibility and applicability of a hybrid freehandSPECT/ultrasound (fh-SPECT/US) imaging concept, with regard to SLN imaging, in patients with breast cancer and malignant melanoma. PATIENTS, METHODS 18 patients with breast cancer or malignant melanoma received standard SLN scintigraphy. Following this, fh-SPECT using declipse®SPECT (SurgicEye, Munich, Germany) was performed, a handheld-gamma camera-based method to visualize activity distribution within a region of interest as a cross-sectional data set. These data were transferred to an ultrasound device and sensor-navigated ultrasound was performed combining fh-SPECT data with ultrasound images, displaying superimposed images. Quality of fh-SPECT and co-registration accuracy was assigned to one of four categories and occurrence of artefacts was assessed. RESULTS In 4/18 examinations, there was a no deviation regarding co-registration of both data sets. For 9/18 patients, there was a deviation of <1 cm (mean 0.7±0.3 cm, range 0.3-1.0 cm). For 3/18 patients, a deviation >1 cm was present (mean 1.7±0.3 cm, range 1.5-2.0 cm). In 2/18 examinations no lymph node was found in the region of highest activity. Fh-SPECT reconstruction artifacts occurred in 6/18 examinations. CONCLUSION The fusion imaging concept combining SLN information with ultrasound images presented here proves to be feasible and technically successful. However, significant technical limitations were shown in fh-SPECT quality and fusion precision. Subject to technical optimisation of SPECT quality and co-registration, a meaningful contribution to the preoperative planning of lymph node therapy is imaginable. Thus, fundamentally a preoperative histological examination by fh-SPECT/US-guided biopsy is possible.
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Affiliation(s)
- M Freesmeyer
- Martin Freesmeyer, M.D., Clinic of Nuclear Medicine, Jena University Hospital, Bachstraße 18, 07743 Jena, Germany, Tel. +49/(0)36 41/93 32 20, Fax +49/(0)36 41/93 32 44, E-mail:
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