1
|
Tartaglione G, Ieria FP, Visconti G, Bartoletti R, Tarantino G, Aloisi D, Gentileschi S, Salgarello M. Rest/Stress Intradermal Lymphoscintigraphy for the Functional Imaging of the Lymphatic System. Clin Nucl Med 2022; 47:1011-1018. [PMID: 36183418 DOI: 10.1097/rlu.0000000000004422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Lymphoscintigraphy is the criterion-standard method for diagnosing lymphedema, and there is no universally standardized imaging modality. In our center, we use a new approach: rest/stress intradermal lymphoscintigraphy. METHODS We tested 231 consecutive patients with suspected lymphedema. All patients were studied after a complex physical therapy program to reduce edema. Two doses of 99m Tc-nanocolloid were injected intradermally. Two static planar scans were taken at rest following tracer injection. Next, patients performed an isotonic muscular exercise for 2 minutes followed by postexercise scans. Subsequently, a prolonged exercise was performed for 30 to 40 minutes, after which delayed scans were taken. Abnormal patterns were distinguished into minor or major findings, according to severity. RESULTS We identified superficial lymphatic vessels and regional lymph nodes in approximately 80% of limbs. Deep vessels were visualized in 26% of limbs. Minor findings were reported in 22.7% of limbs examined, whereas major findings were reported in 53.2% of limbs. CONCLUSION We observed major findings including lymph stagnation, extravasation, or dermal backflow in a significantly higher percentage of limbs with secondary lymphedema than in primary. We also observed the deep lymphatic pathways in a significantly higher percentage of limbs with primary lymphedema. Intradermal radiotracer injection, combined with isotonic muscular exercise, may offer a better and faster imaging of lymphatic pathways, evaluating the effects of muscular exercise on lymphatic drainage. Based on the in-depth information of the lymphatic pathways provided by rest/stress intradermal lymphoscintigraphy, microsurgeons can obtain important functional information to perform supermicrosurgical lymphatic-venous anastomosis or vascularized lymph node transfer.
Collapse
Affiliation(s)
| | | | - Giuseppe Visconti
- Plastic Surgery, Lymphedema Center Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Giulio Tarantino
- Plastic Reconstructive Surgery and Microsurgery, Careggi University Hospital, Florence
| | | | - Stefano Gentileschi
- Plastic Surgery, Lymphedema Center Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Marzia Salgarello
- Plastic Surgery, Lymphedema Center Fondazione Policlinico Universitario A. Gemelli IRCCS
| |
Collapse
|
2
|
Single shot lymphoscintigraphy in breast cancer: Effective single tracer sentinel node detection protocol with reduction in procedural pain. Clin Imaging 2022; 84:43-46. [DOI: 10.1016/j.clinimag.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
|
3
|
Ozdemir S, Corner L, Searcy T, Sharma S, Sharma S. A Practical Technique to Improve Visualization of Sentinel Nodes in Axillary Region on Breast Lymphoscintigraphy: Medial Breast Traction by Patient. J Nucl Med Technol 2021; 50:jnmt.121.262994. [PMID: 34750235 DOI: 10.2967/jnmt.121.262994] [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: 08/04/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
A standard method of performing breast lymphoscintigraphy is anterior and lateral views after periareolar intradermal injection of a radiotracer. However, a sentinel lymph node may be obscured by the activity at injection site, especially on anterior view. Also, breast tissue may cause attenuation to prevent sentinel node visualization. Repeat images during medial traction of breast by patient is an effective technique to improve visualization of sentinel lymph nodes in axillary region.
Collapse
|
4
|
Holliday RM, Jain MK, Accurso JM, Sharma A, Harrison SR, Aloszka DL, Bowman AW. Buffering the Suffering of Breast Lymphoscintigraphy. J Nucl Med Technol 2019; 48:51-53. [PMID: 31182657 DOI: 10.2967/jnmt.119.230011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
Breast lymphoscintigraphy with 99mTc-sulfur colloid is frequently performed before breast-conserving surgery to delineate drainage to a sentinel node. Tracer injection for lymphoscintigraphy can be painful. Our aims were to determine whether administering a solution of buffered lidocaine immediately before lymphoscintigraphy injection could both reduce the patients' pain and increase nuclear medicine technologists' satisfaction with performing the procedure. Methods: A pain scale survey was obtained from patients undergoing breast lymphoscintigraphy with or without buffered lidocaine. Our nuclear medicine technologists were also surveyed for their satisfaction with the procedure, both with and without the addition of buffered lidocaine. Results: The patients' reported pain decreased by 86% with the addition of buffered lidocaine. Technologist satisfaction with performing the procedure increased by 36%. Conclusion: Lidocaine buffered with sodium bicarbonate injected before lymphoscintigraphy significantly reduces pain experienced by the patient and improves nuclear medicine technologist satisfaction in performing the procedure.
Collapse
Affiliation(s)
- Rex M Holliday
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Manoj K Jain
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Joseph M Accurso
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Akash Sharma
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Sara R Harrison
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Debora L Aloszka
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Andrew W Bowman
- Division of Hospital Radiology, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
5
|
Inadvertent Injection of a Breast Implant During Lymphoscintigraphy. Clin Nucl Med 2019; 44:585-586. [PMID: 30829873 DOI: 10.1097/rlu.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 34-year-old woman with history of bilateral saline implants, invasive ductal carcinoma of the right breast, and suspicious left breast calcifications was referred for left breast lymphoscintigraphy before bilateral mastectomy. A total of 3.2 mCi of Tc-filtered sulfur colloid was administered with 3 subdermal injections in the superior, lateral, and inferior periareolar left breast in the late afternoon preceding the day of surgery. Imaging identified radiotracer uptake within a dense, circular area deep to the injection sites within the left breast, compatible with implant puncture and radiotracer administration within the indwelling breast implant.
Collapse
|
6
|
Freebody J, Fernando S, Rossleigh MA. Triple-site radiotracer application in breast lymphoscintigraphy and sentinel node discordance. World J Nucl Med 2019; 18:127-131. [PMID: 31040742 PMCID: PMC6476254 DOI: 10.4103/wjnm.wjnm_32_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sentinel lymph node (SLN) biopsy (SLNB) has demonstrated accuracy in the axillary staging of breast cancer patients. Despite variability in selection criteria and technique, an SLN is consistently identified in approximately 96% of cases and in most series predicts the status of remaining axillary LNs in >95% of cases. The false-negative rate of sentinel lymph node biopsy (SLNB) was originally reported as 5%–10% (sensitivity 90%–95%), but improved rates are attainable by experienced surgeons. Radiolocalization with lymphoscintigraphy (LSG) increases SLN identification rates. LSG is a useful tool to establish the abnormal lymphatic drainage patterns and to detect the extra-axillary nodes, particularly internal mammary nodes. Despite controversy regarding the optimal injection method, studies have generally suggested high concordance between the various radiotracer application sites and axillary SLN identification. Discordant SLN identification would have implications for nodal staging as the true SLN might not be identified with individual injection techniques. In the current study, imaging from consecutive patients presenting for breast LSG over a-19 month period was retrospectively reviewed. Radiotracer application was performed with simultaneous injection of peritumoral, subcutaneous, and subareolar regions. This application method provided a mechanism to assess the LSG drainage patterns with a view to assessing injection site concordance and SLN identification rates. Data from 123 breast LSG patients were reviewed. Using our radiotracer technique, the axillary SLN identification rate was 98%. A single axillary node was detected in 110, two axillary nodes were detected in 10, and no axillary node was detected in three patients. Among those 10 patients in whom two axillary nodes were seen, at least two cases of discordant drainage occurred from different injection sites. This study demonstrates that different LSG injection sites can result in the identification of different axillary sentinel nodes although this appears to be a rare event. This finding may be of clinical importance if the true SLN is sought. In addition, the multisite injection technique appears to be an optimal method of axillary SLN identification, with high SLN detection rates.
Collapse
Affiliation(s)
- John Freebody
- Department of Nuclear Medicine and PET, The Prince of Wales and Sydney Children's Hospitals, Randwick, NSW, Australia
| | - Shane Fernando
- Department of Nuclear Medicine and PET, The Prince of Wales and Sydney Children's Hospitals, Randwick, NSW, Australia
| | - Monica A Rossleigh
- Department of Nuclear Medicine and PET, The Prince of Wales and Sydney Children's Hospitals, Randwick, NSW, Australia
| |
Collapse
|
7
|
Canning S, Bryson-Campbell M, Suryavanshi R. Effect of Topical Anesthetic Cream on Pain During Periareolar Injection of Technetium Tc99m Sulfur Colloid for Sentinel Lymph Node Biopsy in Breast Cancer: A Randomized Control Trial. J Med Imaging Radiat Sci 2018; 49:44-48. [PMID: 30479287 DOI: 10.1016/j.jmir.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/14/2017] [Accepted: 08/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Injection of Tc99m to localize nodes for sentinel lymph node biopsy is reported by patients as very painful. The purpose of this study was to determine if anesthetic cream reduces pain associated with periareolar injection of Tc99m and to help elucidate conflicting literature regarding the efficacy of anesthetic cream for this procedure. METHODS A randomized, double-blind, placebo-controlled methodology was used for adult females with breast cancer undergoing periareolar injection of Tc99m for sentinel lymph node biopsy. Pain levels were compared using anesthetic cream (2.5% lidocaine/2.5% prilocaine) vs. placebo. Patient exclusion criteria included use of opioids or adjuvant pain medication or injecting Tc99m the day before surgery. The Numerical Rating Scale was used to assess pain levels immediately after the injections. RESULTS Comparing 23 experimental and 26 control patients, there was no significant difference between the experimental (median = 4) and the control group (median = 5) on level of pain experienced U= 0.492, P > .05. CONCLUSIONS The experimental group had a slightly lower median pain score; however, there was no statistically significant difference between those who used the cream compared with those who used a placebo, supporting the conclusion that anesthetic cream does not reduce pain during Tc99m injections. This study adds to the current literature to provide a stronger position that there is no benefit to using anesthetic cream for this procedure.
Collapse
Affiliation(s)
- Sarah Canning
- Cancer Care Assessment and Treatment Center (CCATC), Bluewater Health, Sarnia, Ontario, Canada.
| | | | | |
Collapse
|
8
|
Desirable Properties of Radiopharmaceuticals for Sentinel Node Mapping in Patients With Breast Cancer Given the Paradigm Shift in Patient Management. Clin Nucl Med 2017; 42:275-279. [PMID: 28166148 DOI: 10.1097/rlu.0000000000001565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Over the past 2 decades, lymphoscintigraphy and sentinel node biopsy have become widely accepted and are used by surgeons to stage many solid cancers, especially breast cancer. However, despite growing experience, there are a number of unresolved issues. In addition, the impact of a new radiopharmaceutical remains to be determined. The present article addresses some of these issues (either unresolved, recurrent, or newly emerged), with a focus on the properties of radiopharmaceuticals used for sentinel node mapping in breast cancer.
Collapse
|
9
|
Kang J, Chang JH, Kim SM, Lee HJ, Kim H, Wilson BC, Song TK. Real-time sentinel lymph node biopsy guidance using combined ultrasound, photoacoustic, fluorescence imaging: in vivo proof-of-principle and validation with nodal obstruction. Sci Rep 2017; 7:45008. [PMID: 28327582 PMCID: PMC5361205 DOI: 10.1038/srep45008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/20/2017] [Indexed: 12/20/2022] Open
Abstract
Precise sentinel lymph node (SLN) identification is crucial not only for accurate diagnosis of micro-metastases at an early stage of cancer progression but also for reducing the number of SLN biopsies (SLNB) to minimize their severe side effects. Furthermore, it is desirable that an SLNB guidance should be as safe as possible in routine clinical use. Although there are currently various SLNB guidance methods for pre-operative or intra-operative assessment, none are ideal. We propose a real-time SLNB guidance method using contrast-enhanced tri-modal images (i.e., ultrasound, photoacoustic, and fluorescence) acquired by a recently developed hand-held tri-modal probe. The major advantage of tri-modal imaging is demonstrated here through an in vivo study of the technically-difficult case of nodal obstruction that frequently leads to false-negative results in patients. The results in a tumor model in rabbits and normal controls showed that tri-modal imaging is capable of clearly identifying obstructed SLNs and of indicating their metastatic involvement. Based on these findings, we propose an SLNB protocol to help surgeons take full advantage of the complementary information obtained from tri-modal imaging, including for pre-operative localization, intra-operative biopsy guidance and post-operative analysis.
Collapse
Affiliation(s)
- Jeeun Kang
- Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea
| | - Jin Ho Chang
- Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea.,Sogang Institute of Advanced Technology, Sogang University, Seoul, 04107, South Korea.,Department of Biomedical Engineering, Sogang University, Seoul, 04107, South Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University of Bundang Hospital, Kyeonggi-do, 13620, South Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University of Bundang Hospital, Kyeonggi-do, 13620, South Korea
| | - Haemin Kim
- Department of Biomedical Engineering, Sogang University, Seoul, 04107, South Korea
| | - Brian C Wilson
- Princess Margaret Cancer Centre, University Health Network, M5G 1L7, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Ontario M5G 1L7, Canada
| | - Tai-Kyong Song
- Department of Electronic Engineering, Sogang University, Seoul, 04107, South Korea
| |
Collapse
|
10
|
Sentinel Node in Oral Cancer: The Nuclear Medicine Aspects. A Survey from the Sentinel European Node Trial. Clin Nucl Med 2017; 41:534-42. [PMID: 27088386 DOI: 10.1097/rlu.0000000000001241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Nuclear imaging plays a crucial role in lymphatic mapping of oral cancer. This evaluation represents a subanalysis of the original multicenter SENT trial data set, involving 434 patients with T1-T2, N0, and M0 oral squamous cell carcinoma. The impact of acquisition techniques, tracer injection timing relative to surgery, and causes of false-negative rate were assessed. METHODS Three to 24 hours before surgery, all patients received a dose of Tc-nanocolloid (10-175 MBq), followed by lymphoscintigraphy. According to institutional protocols, all patients underwent preoperative dynamic/static scan and/or SPECT/CT. RESULTS Lymphoscintigraphy identified 723 lymphatic basins. 1398 sentinel lymph nodes (SNs) were biopsied (3.2 SN per patient; range, 1-10). Dynamic scan allowed the differentiation of sentinel nodes from second tier lymph nodes. SPECT/CT allowed more accurate anatomical localization and estimated SN depth more efficiently. After pathological examination, 9.9% of the SN excised (138 of 1398 SNs) showed metastases. The first neck level (NL) containing SN+ was NL I in 28.6%, NL IIa in 44.8%, NL IIb in 2.8%, NL III in 17.1%, and NL IV in 6.7% of positive patients. Approximately 96% of positive SNs were localized in the first and second lymphatic basin visualized using lymphoscintigraphy. After neck dissection, the SN+ was the only lymph node containing metastasis in approximately 80% of patients. CONCLUSIONS Best results were observed using a dynamic scan in combination with SPECT/CT. A shorter interval between tracer injection, imaging, and surgery resulted in a lower false-negative rate. At least 2 NLs have to be harvested, as this may increase the detection of lymphatic metastases.
Collapse
|
11
|
SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients With Breast Cancer: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:94-8. [PMID: 27100165 DOI: 10.1097/imi.0000000000000257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the impact of the use of single-photon emission computed tomography fused with computed tomography (SPECT-CT) on thoracoscopic biopsy of sentinel lymph nodes (SLNs) in the internal mammary chain in patients with breast cancer by evaluating resultant changes in staging and their clinical implications. METHODS Between September 2010 and January 2014, we performed lymphoscintigraphy-assisted thoracoscopic biopsy of the internal mammary chain SLN in 20 patients with breast cancer. Single-photon emission computed tomography fused with computed tomography was also used in 13 of these patients. The sentinel nodes were surgically identified with the aid of a gamma probe. RESULTS Sentinel lymph nodes were identified surgically in 19 of 20 patients. In the 13 patients in whom SPECT-CT was used, it readily identified SLNs, especially when they were located over an intercostal space. Change of staging occurred in three patients (15%), two of whom accordingly received adjuvant radiotherapy to the internal thoracic chain. CONCLUSIONS Compared with lymphoscintigraphy alone, the use of SPECT-CT improves localization of the SLN in the internal mammary chain, allowing more accurate planning of each individual's treatment.
Collapse
|
12
|
Piato JRM, Filassi JR, Vega AJMD, Coura-Filho GB, Aguiar FN, Porciuncula LMTP, Dória MT, Soares JM, Baracat EC. SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients with Breast Cancer: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- José; Roberto Morales Piato
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - José; Roberto Filassi
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | | | | | - Fernando Nalesso Aguiar
- Departamento de Patologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Maíra Teixeira Dória
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - José Maria Soares
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Edmund Chada Baracat
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| |
Collapse
|
13
|
Moncayo VM, Aarsvold JN, Alazraki NP. Lymphoscintigraphy and Sentinel Nodes. J Nucl Med 2015; 56:901-7. [DOI: 10.2967/jnumed.114.141432] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/23/2015] [Indexed: 12/29/2022] Open
|
14
|
Hall NC, Povoski SP, Zhang J, Knopp MV, Martin EW. Use of intraoperative nuclear medicine imaging technology: strategy for improved patient management. Expert Rev Med Devices 2014; 10:149-52. [DOI: 10.1586/erd.13.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Proulx ST, Luciani P, Alitalo A, Mumprecht V, Christiansen AJ, Huggenberger R, Leroux JC, Detmar M. Non-invasive dynamic near-infrared imaging and quantification of vascular leakage in vivo. Angiogenesis 2013; 16:525-40. [PMID: 23325334 DOI: 10.1007/s10456-013-9332-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/03/2013] [Indexed: 12/28/2022]
Abstract
Preclinical vascular research has been hindered by a lack of methods that can sensitively image and quantify vascular perfusion and leakage in vivo. In this study, we have developed dynamic near-infrared imaging methods to repeatedly visualize and quantify vascular leakage in mouse skin in vivo, and we have applied these methods to transgenic mice with overexpression of vascular endothelial growth factors VEGF-A or -C. Near-infrared dye conjugates were developed to identify a suitable vascular tracer that had a prolonged circulation lifetime and slow leakage into normal tissue after intravenous injection. Dynamic simultaneous imaging of ear skin and a large blood vessel in the leg enabled determination of the intravascular signal (blood volume fraction) from the tissue signal shortly after injection and quantifications of vascular leakage into the extravascular tissue over time. This method allowed for the sensitive detection of increased blood vascularity and leakage rates in K14-VEGF-A transgenic mice and also reliably measured inflammation-induced changes of vascularity and leakage over time in the same mice. Measurements after injection of recombinant VEGF-A surprisingly revealed increased blood vascular leakage and lymphatic clearance in K14-VEGF-C transgenic mice which have an expanded cutaneous lymphatic vessel network, potentially indicating unanticipated effects of lymphatic drainage on vascular leakage. Increased vascular leakage was also detected in subcutaneous tumors, confirming that the method can also be applied to deeper tissues. This new imaging method might facilitate longitudinal investigations of the in vivo effects of drug candidates, including angiogenesis inhibitors, in preclinical disease models.
Collapse
Affiliation(s)
- Steven T Proulx
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Wolfgang-Pauli-Str. 10, HCI H303, 8093 Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Amoui M, Akbari ME, Tajeddini A, Nafisi N, Raziei G, Modares SM, Hashemi M. Value of sentinel lymph node biopsy in breast cancer surgery with simple pathology facilities--an Iranian local experience with a review of potential causes of false negative results. Asian Pac J Cancer Prev 2013; 13:5385-9. [PMID: 23317188 DOI: 10.7314/apjcp.2012.13.11.5385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in node- negative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry. MATERIAL AND METHOD Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery. RESULTS 78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected. CONCLUSION SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.
Collapse
Affiliation(s)
- Mahasti Amoui
- Cancer Research Center, Shohadae Tajrish Hospital, Nuclear Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | |
Collapse
|
17
|
Breast cancer sentinel node scintigraphy: differences between imaging results 1 and 2 h after injection. Nucl Med Commun 2012; 33:1138-43. [PMID: 22863761 DOI: 10.1097/mnm.0b013e3283575a50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Timing of image acquisition in breast cancer sentinel node scintigraphy remains a subject of debate. Therefore, the performance of our protocol in which images are acquired 1 and 2 h after injection was evaluated. The results of sentinel node scintigraphy 1 and 2 h after injection were compared with regard to the sentinel lymph nodes visualized. METHODS We studied 132 patients who were consecutively referred for sentinel lymph node biopsy. 99mTc-albumine nanocolloid (120 MBq) was injected peritumourally into patients with palpable tumours and intratumourally into patients with nonpalpable tumours. All scintigraphic images taken for the sentinel node procedure were evaluated. The number of sentinel nodes per anatomic localization and the interpretability of the images were scored. RESULTS A total of 132 patients underwent sentinel node scintigraphy 1 h after injection. Of these, 117 patients also underwent sentinel node scintigraphy 2 h after injection. An axillary sentinel node was visualized in 79.5 and 95.7% of patients, respectively, 1 and 2 h after injection. In 20.5% of the patients the images acquired 1 h after injection did not show a sentinel node. Furthermore, in all procedures, the images 1 h after injection were of no added value to those acquired 2 h after injection. CONCLUSION Scintigraphic imaging 2 h after a single peritumoural or intratumoural administration of about 120 MBq 99mTc-albumine nanocolloid yields an axillary sentinel node in over 95% of cases. Imaging 1 h after injection is of no additional value and can be omitted.
Collapse
|
18
|
Zuckier LS. Hybrid imaging in planar scintigraphy: new implementations and historical precedents. Semin Nucl Med 2012; 42:62-72. [PMID: 22117814 DOI: 10.1053/j.semnuclmed.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fusion of tomographic radionuclide studies with anatomical examinations has become standard practice in positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging. Nonetheless, fusion of planar scintigraphic images with an anatomical modality remains distinctly uncommon, although methods to do so have appeared sporadically in the literature during the past 2 decades. In this article we review several techniques that have been used to combine planar scintigraphic images with radiographs and visual (photographic) images. Rigid or affine transformations have been performed to co-register the planar images with each other using custom, commercial, or public domain software. Display of the hybrid images has been achieved primarily with nonselective color-fusion methods. Promising efforts are underway to develop a technique of fusing planar lymphoscintigraphic images with CT topograms (scout images) obtained on the SPECT-CT camera in a manner that compensates for position-dependent variation in magnification that affects the CT scout. An advantage of this approach is that both of the component images are acquired on the same gantry, without need for repositioning of the patient. It is instructive to note that techniques of fusing rectilinear scans with radiographic and visual images were first developed more than 50 years ago. The revisiting of these methods after many decades reflects a fundamental need for spatial orientation in nuclear medicine that fusion imaging can also bring to planar scintigraphic studies.
Collapse
|
19
|
Abstract
BACKGROUND It has commonly been assumed that deeper facelift dissection causes greater and more prolonged swelling. OBJECTIVES In this preliminary report, the authors compare the lymphatic reconstitution after multiple techniques of rhytidectomy by means of dynamic lymphoscintigraphy. METHODS Three patients were enrolled in this study. All three were female, were similar in age, and exhibited similar signs and degrees of facial aging. Each woman underwent a facelift with a different technique: (1) subcutaneous dissection with superficial musculoaponeurotic system (SMAS) plication, (2) subcutaneous dissection with SMASectomy, and (3) a "high SMAS" composite facelift. Postoperatively, (99m)Tc-sulfur colloid was injected into a standardized infraorbital location in each patient to compare patterns of lymphatic drainage using lymphoscintigraphy. Postoperative scans at two weeks, six weeks, three months, six months, and one year were compared to the preoperative scans taken seven days prior to surgery. RESULTS All rhytidectomy techniques appeared to temporarily create a significant and similar degree of interruption in lymphatic drainage. There was a subtotal recovery of lymphatic pathways within three months and complete return to baseline drainage pattern after six months, regardless of surgical technique. CONCLUSIONS Based on the results of this study, it appears that the extent of facial dissection, rather than the depth, is the most significant factor in postoperative edema.
Collapse
Affiliation(s)
- Ricardo A Meade
- The University of Texas Southwestern Medical Center, Dallas,TX, USA.
| | | | | | | |
Collapse
|
20
|
Leong SPL, Kim J, Ross M, Faries M, Scoggins CR, Metz WLR, Cope FO, Orahood RC. A phase 2 study of (99m)Tc-tilmanocept in the detection of sentinel lymph nodes in melanoma and breast cancer. Ann Surg Oncol 2011; 18:961-9. [PMID: 21331809 DOI: 10.1245/s10434-010-1524-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several (99m)Tc-labeled agents that are not approved by the U.S. Food and Drug Administration are used for lymphatic mapping. A new low-molecular-weight mannose receptor-based, reticuloendothelial cell-directed, (99m)Tc-labeled lymphatic imaging agent, (99m)Tc-tilmanocept, was used for lymphatic mapping of sentinel lymph nodes (SLNs) from patients with primary breast cancer or melanoma malignancies. This novel molecular species provides the basis for potentially enhanced SLN mapping reliability. METHODS In a prospectively planned, open-label phase 2 clinical study, (99m)Tc-tilmanocept was injected into breast cancer and cutaneous melanoma patients before intraoperative lymphatic mapping. Injection technique, preoperative lymphoscintigraphy (LS), and intraoperative lymphatic mapping with a handheld gamma detection probe were performed by investigators per standard practice. RESULTS Seventy-eight patients underwent (99m)Tc-tilmanocept injection and were evaluated (47 melanoma, 31 breast cancer). For those whom LS was performed (55 patients, 70.5%), a (99m)Tc-tilmanocept hot spot was identified in 94.5% of LS patients before surgery. Intraoperatively, (99m)Tc-tilmanocept identified at least one regional SLN in 75 (96.2%) of 78 patients: 46 (97.9%) of 47 in melanoma and 29 (93.5%) of 31 in breast cancer cases. Tissue specificity of (99m)Tc-tilmanocept for lymph nodes was 100%, displaying 95.1% mapping sensitivity by localizing in 173 of 182 nodes removed during surgery. The overall proportion of (99m)Tc-tilmanocept-identified nodes that contained metastatic disease was 13.7%. Five procedure-related serious adverse events occurred, none related to (99m)Tc-tilmanocept. CONCLUSIONS Our results demonstrate the safety and efficacy of (99m)Tc-tilmanocept for use in intraoperative lymphatic mapping. The high intraoperative localization and lymph node specificity of (99m)Tc-tilmanocept and the identification of metastatic disease within the nodes suggest SLNs are effectively identified by this novel mannose receptor-targeted molecule.
Collapse
Affiliation(s)
- Stanley P L Leong
- California Pacific Medical Center and Sutter Pacific Medical Foundation and Research Institute, University of California, San Francisco, CA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Patient-Specific Modeling of Breast Biomechanics with Applications to Breast Cancer Detection and Treatment. PATIENT-SPECIFIC MODELING IN TOMORROW'S MEDICINE 2011. [DOI: 10.1007/8415_2011_92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
22
|
Hybrid Modality Fusion of Planar Scintigrams and CT Topograms to Localize Sentinel Lymph Nodes in Breast Lymphoscintigraphy: Technical Description and Phantom Studies. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2010; 2011:298102. [PMID: 21490727 PMCID: PMC3065894 DOI: 10.1155/2011/298102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 10/11/2010] [Indexed: 11/18/2022]
Abstract
Lymphoscintigraphy is a nuclear medicine procedure that is used to detect sentinel lymph nodes (SLNs). This project sought to investigate fusion of planar scintigrams with CT topograms as a means of improving the anatomic reference for the SLN localization. Heretofore, the most common lymphoscintigraphy localization method has been backlighting with a (57)Co sheet source. Currently, the most precise method of localization through hybrid SPECT/CT increases the patient absorbed dose by a factor of 34 to 585 (depending on the specific CT technique factors) over the conventional (57)Co backlighting. The new approach described herein also uses a SPECT/CT scanner, which provides mechanically aligned planar scintigram and CT topogram data sets, but only increases the dose by a factor of two over that from (57)Co backlighting. Planar nuclear medicine image fusion with CT topograms has been proven feasible and offers a clinically suitable compromise between improved anatomic details and minimally increased radiation dose.
Collapse
|
23
|
Mainiero MB. Regional Lymph Node Staging in Breast Cancer: The Increasing Role of Imaging and Ultrasound-Guided Axillary Lymph Node Fine Needle Aspiration. Radiol Clin North Am 2010; 48:989-97. [DOI: 10.1016/j.rcl.2010.06.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
24
|
Tafreshi NK, Kumar V, Morse DL, Gatenby RA. Molecular and Functional Imaging of Breast Cancer. Cancer Control 2010; 17:143-55. [DOI: 10.1177/107327481001700302] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Significant efforts have been directed toward developing and enhancing imaging methods for the early detection, diagnosis, and characterization of small breast tumors. Molecular and functional imaging sets the stage for enhancement of current methodology. Methods Current imaging modalities are described based on the molecular characteristics of normal and malignant tissue. New molecular imaging methods that have the potential for clinical use are also discussed. Results: Dynamic contrast-enhanced magnetic resonance imaging is more sensitive than mammography in BRCA1 carriers. It is used in screening and in the early evaluation of neoadjuvant therapy. Positron emission mammography is 91% sensitive and 93% specific in detecting primary breast cancers. Sentinel node scintigraphy is a key component of axillary lymph node evaluation. Other imaging modalities being studied include Tc99m sestamibi, radiolabeled thymidine or uridine, estrogen receptor imaging, magnetic resonance spectroscopy, and diffusion magnetic resonance imaging. Conclusions Molecular and functional imaging of the breast will likely alter clinical practice in diagnosing and staging primary breast cancer and assessing response to therapy since it will provide earlier information regarding the underlying biology of individual breast cancers, tumor stage, potential treatment strategies, and biomarkers for early evaluation of treatment effects.
Collapse
Affiliation(s)
| | - Virendra Kumar
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - David L. Morse
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | |
Collapse
|
25
|
Standard versus pH-adjusted and lidocaine supplemented radiocolloid for patients undergoing sentinel-lymph-node mapping and biopsy for early breast cancer (PASSION-P trial): a double-blind, randomised controlled trial. Lancet Oncol 2009; 10:849-54. [PMID: 19664956 DOI: 10.1016/s1470-2045(09)70194-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel-lymph-node (SLN) mapping and biopsy maintains staging accuracy in early breast cancer and identifies patients for selective lymphadenectomy. SLN mapping requires injection of technetium-99m-sulfur colloid-an effective but sometimes painful method, for which better pain-management strategies are needed. In this randomised, double-blind trial, we compared degree of pain between standard radiocolloid injection and pH-adjusted and lidocaine-supplemented formulations for patients undergoing SLN mapping for breast cancer. METHODS Between Jan 13, 2006, and April 30, 2009, 140 patients with early breast cancer were randomly assigned in a 1:1:1:1 fashion to receive the standard topical 4% lidocaine cream and injection of [(99m)Tc]Tc-sulfur colloid (n=35), or to one of three other study groups: topical placebo cream and injection of Tc-sulfur colloid containing either sodium bicarbonate (n=35), 1% lidocaine (n=35), or sodium bicarbonate and 1% lidocaine (n=35). The randomisation sequence was computer generated, and all patients and investigators were masked to treatment allocation. The primary endpoint was patient-reported breast pain immediately after radioisotope injection, using the Wong-Baker FACES pain rating scale and McGill pain questionnaire, analysed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT00940199. FINDINGS 19 of the 140 patients enrolled were excluded from analysis: nine declined study participation or sought care elsewhere, nine did not undergo SLN mapping because of disease extent or a technical problem, and one had unreliable data. There were no adverse events. Mean pain scores on the Wong-Baker scale (0-10) were: 6.0 (SD 2.6) for those who received standard of practice, 4.7 (3.0) for those who received radiocolloid plus bicarbonate, 1.6 (1.4) for those who received radiocolloid plus 1% lidocaine, and 1.6 (1.3) for those who received radiocolloid plus bicarbonate and 1% lidocaine (p<0.0001). Mean pain rating, according to the McGill questionnaire (0-78), was 17.5 (SD 11.8) for the standard-of-care group, 15.4 (14.4) for the sodium bicarbonate group, 4.6 (4.5) for the 1% lidocaine group, and 3.4 (5.1) for the sodium bicarbonate plus 1% lidocaine group (p<0.0001). SLN identification rates for each group were: 96% for the standard of care, 97% for sodium bicarbonate, 90% for 1% lidocaine, and 90% for sodium bicarbonate plus 1% lidocaine group (p=0.56). INTERPRETATION For centres that use radiocolloid injections for SLN mapping in patients with early breast cancer, the addition of 1% lidocaine to the radioisotope solution can improve patient comfort, without compromising SLN identification. FUNDING US Military Cancer Institute, the Clinical Breast Care Project, and the Army Regional Anesthesia and Pain Management Initiative.
Collapse
|
26
|
Stell VH, Flippo-Morton TS, Norton HJ, White RL. Effect of Intraoperative Radiocolloid Injection on Sentinel Lymph Node Biopsy in Patients with Breast Cancer. Ann Surg Oncol 2009; 16:2300-4. [DOI: 10.1245/s10434-009-0537-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 05/05/2009] [Accepted: 05/06/2009] [Indexed: 12/30/2022]
|
27
|
Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography. Aesthetic Plast Surg 2008; 32:879-88. [PMID: 18661171 DOI: 10.1007/s00266-008-9212-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG). METHODS Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p \ 0.05 significant, or p \ 0.017 when Bonferroni correction was applied. RESULTS All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG. CONCLUSION The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.
Collapse
|
28
|
Sado HN, Graf RM, Timi JRR, Urban CA, Yamada AS, Woellner LC, Ferreira EDC, Matias JEF. Linfonodo sentinela após mamoplastia de aumento pela via transaxilar: estudo prospectivo controlado por meio de linfocintilografia em 43 pacientes. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000500004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar se a mamoplastia de aumento pela via transaxilar apresenta potencial de prejudicar a identificação futura do linfonodo sentinela. MATERIAIS E MÉTODOS: Estudo prospectivo controlado em que foram selecionadas 22 pacientes divididas em grupo pós-mamoplastia e grupo controle, totalizando 43 mamas (22 no grupo pós-mamoplastia e 21 no grupo controle) avaliadas por meio de linfocintilografia imediatamente após injeções periareolares de fitato-99mTc. Os testes estatísticos consideraram como diferenças significativas valores de p < 0,05. RESULTADOS: Todas as mamas do grupo pós-mamoplastia apresentaram drenagem linfática para a cadeia axilar, sem diferença com o grupo controle (p = 0,488). A média de linfonodos captantes foi de 1,27 ± 0,46 no grupo pós-mamoplastia e 1,33 ± 0,58 no grupo controle (p = 0,895). A média de tempo para visualização do primeiro linfonodo foi de 3,14 ± 4,42 minutos no grupo pós-mamoplastia e 5,48 ± 5,06 minutos no grupo controle, novamente sem diferença significativa (p = 0,136). CONCLUSÃO: A mamoplastia de aumento pela via transaxilar não acarretou prejuízo na identificação futura do linfonodo sentinela.
Collapse
|
29
|
Thompson M, Korourian S, Henry-Tillman R, Adkins L, Mumford S, Smith M, Klimberg VS. Intraoperative Radioisotope Injection for Sentinel Lymph Node Biopsy. Ann Surg Oncol 2008; 15:3216-21. [DOI: 10.1245/s10434-008-0010-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 05/20/2008] [Accepted: 05/21/2008] [Indexed: 11/18/2022]
|
30
|
Graf R, Sado H. Transaxillary Breast Augmentation: Two Breast Cancer Patients with Successful Sentinel Lymph Node Diagnosis. Aesthetic Plast Surg 2007. [DOI: 10.1007/s00266-007-0035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Argon AM, Duygun U, Acar E, Daglioz G, Yenjay L, Zekioglu O, Kapkac M. The use of periareolar intradermal Tc-99m tin colloid and peritumoral intraparenchymal isosulfan blue dye injections for determination of the sentinel lymph node. Clin Nucl Med 2007; 31:795-800. [PMID: 17117076 DOI: 10.1097/01.rlu.0000246855.80027.b7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the use of lymphoscintigraphy, blue dye, and gamma probe detection methods for determination of the sentinel lymph node (SLN) using both periareolar intradermal injection of Tc-99m tin colloid and peritumoral intraparenchymal injection of isosulfan blue dye. METHODS One hundred patients with T1-2 breast cancer and clinically negative nodes were enrolled in the present study. The study was composed of 2 groups. Backup axillary lymph node dissection (ALND) was mandatory in group 1 (20 patients) regardless of their lymph node status. In group 2 (80 patients), complete ALND was performed when intraoperative frozen section analysis of SLN revealed metastases. Otherwise, only SLN biopsy was performed without ALND. One day before surgery, Tc-99m tin colloid was injected at 4 periareolar sites intradermally. Lymphoscintigraphy was performed 1 to 2 hours after injection of the radiocolloid. Twenty minutes before surgery, isosulfan blue dye was injected into parenchyma surrounding the tumor or the biopsy cavity. RESULTS The detection rates of SLN and false-negative rate of lymphoscintigraphy, blue dye, and gamma probe detection were 85%, 95% 100%, and 0% in group 1, 91%, 87%, and 95% in group 2, respectively. Detection rate by the combination of blue dye and radio tracer was 98%. CONCLUSIONS According to the results of our study, we conclude that perioareolar intradermal injection of Tc-99m tin colloid combined with peritumoral intraparenchymal injection of blue dye is an accurate and easy method of locating the sentinel node with very high detection rates. It is recommended that the combination of all methods such as lymphoscintigraphy, blue dye, and gamma probe application will increase the success rate of SLN detection in patients with breast cancer.
Collapse
Affiliation(s)
- Aziz Murat Argon
- Department of Nuclear Medicine, Ege University Medical Faculty, Izmir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
32
|
Tsushima H, Takayama T, Kizu H, Yamanaga T, Shimonishi Y, Kosakai K, Murai M, Onoguchi M. Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients. Ann Nucl Med 2007; 21:123-8. [PMID: 17424979 DOI: 10.1007/bf03033990] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the advantage of upright position imaging with a medium-energy collimator for the detection of sentinel lymph node (SLN). METHODS Thirty-four patients with operable breast cancer underwent sentinel node lymphoscintigraphy with 99mTc-tin colloid. Images were obtained in 5 different positions and paired images from the same patient were compared using side-by-side interpretation. Images were compared in 3 groups: group 1 (anterior view); supine (SAV) vs. upright (UAV), group 2 (oblique view); supine (SOV) vs. upright (UOV), and group 3 (oblique view); modified supine (MOV) vs. UOV. Image quality was evaluated using a 3-grade scale of clear, faint, and equivocal depiction, and correlated to 3 parameters: distance from injection site to lymph node (hot node), counts in hot node, and image contrast. Parameters in group 1 were compared by classifying the primary tumor site into 4 subregions. RESULTS Image quality in all 3 groups was more enhanced on the image obtained in the upright position than that in the supine position. Obtaining images in an upright position increased the mean distances by 1.5-3.2 cm, and mean contrasts were significantly increased by 0.13-0.31 (p < 0.05). It was shown that image quality was more greatly affected by image contrast than by counts in the hot node. Image contrast of 0.5 seemed an appropriate threshold level for detection of the hot node. On comparison of tumor sites, the upper outer quadrant (C) region of the 4 subregions demonstrated greater contrast enhancement on upright position images. CONCLUSION Clinical images obtained in an upright position with a medium-energy collimator were superior to those obtained in a supine position. Use of this procedure is recommended to enhance lymph node detection on sentinel node lymphoscintigraphy.
Collapse
Affiliation(s)
- Hiroyuki Tsushima
- Department of Radiology, Osaka City University Hospital, Osaka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 1: sentinel node lymphoscintigraphy in malignant melanoma. Br J Radiol 2007; 80:132-9. [PMID: 16728415 DOI: 10.1259/bjr/20286459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Radionuclide imaging of the lymphatic system has a major role in the management of two main patient groups. First, pre-operative lymphoscintigraphy is a highly accurate method of sentinel node localization and can help guide minimally invasive surgery in a variety of tumour groups. Second, lymphoscintigraphy can play a pivotal role in assessing the cause of extremity swelling. This is the first of two pictorial essays on radionuclide imaging of the lymphatic system and will focus on sentinel node imaging in malignant melanoma. Regional nodal sampling is routinely performed in an increasing number of tumour groups and is well established in malignant melanoma and breast carcinoma. Careful attention to technical performance and image interpretation is essential to maximize the clinical utility of the test. This article provides a pictorial review of the interpretative pearls and pitfalls of sentinel node lymphoscintigraphy in malignant melanoma patients.
Collapse
Affiliation(s)
- A F Scarsbrook
- Department of Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | | | | |
Collapse
|
34
|
Madsen E, Gobardhan P, Bongers V, Albregts M, Burgmans J, De Hooge P, Van Gorp J, van Dalen T. The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol 2007. [PMID: 17253106 DOI: 10.1245/s10343-006-9230-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Since the introduction of the sentinel lymph node (SLN) biopsy in breast cancer patients there is a renewed interest in lymphatic drainage to the internal mammary (IM) chain nodes. We evaluated the frequency of lymphatic drainage to the IM chain, the rate of SLNs that contain metastases and the clinical implications of IM LN metastases. METHODS Between June 1999 and April 2005 506 consecutive patients underwent SLN biopsy as a staging procedure for clinically T1-2N0 breast cancer. In all patients preoperative lymphoscintigraphy was combined with the intraoperative use of a gammaprobe. In patients with IM SLNs visualized on lymphoscintigraphy, LNs were extirpated through an intercostal parasternal incision. RESULTS SLNs were visualized by preoperative lymphoscintigraphy in 99% of all patients (502/506): axillary SLNs in 499 patients (99%), ipsilateral IM LNs in 109 patients (22%). In 85 patients with visualized IM SLNs the IM nodes could be removed (78%). In 20 of the latter 85 patients IM SLNs contained metastases (24%). IM metastases were associated with axillary LN metastases (P < 0.001). In 17 patients IM metastases led to extension of the radiotherapy field, while additional (adjuvant) systemic therapy was given in six patients. CONCLUSION SLNs in the IM chain are common in breast cancer patients and can be extirpated in the majority of these patients. The proportion of patients in whom radiotherapeutic treatment was adjusted due to IM LN metastases was substantial. We advocate retrieval of IM SLNs when visualized by preoperative lymphoscintigraphy.
Collapse
Affiliation(s)
- Eve Madsen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Madsen EVE, Gobardhan PD, Bongers V, Albregts M, Burgmans JPJ, De Hooge P, Van Gorp J, van Dalen T. The impact on post-surgical treatment of sentinel lymph node biopsy of internal mammary lymph nodes in patients with breast cancer. Ann Surg Oncol 2007; 14:1486-92. [PMID: 17253106 PMCID: PMC1914262 DOI: 10.1245/s10434-006-9230-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 08/08/2006] [Indexed: 11/18/2022]
Abstract
Background Since the introduction of the sentinel lymph node (SLN) biopsy in breast cancer patients there is a renewed interest in lymphatic drainage to the internal mammary (IM) chain nodes. We evaluated the frequency of lymphatic drainage to the IM chain, the rate of SLNs that contain metastases and the clinical implications of IM LN metastases. Methods Between June 1999 and April 2005 506 consecutive patients underwent SLN biopsy as a staging procedure for clinically T1-2N0 breast cancer. In all patients preoperative lymphoscintigraphy was combined with the intraoperative use of a gammaprobe. In patients with IM SLNs visualized on lymphoscintigraphy, LNs were extirpated through an intercostal parasternal incision. Results SLNs were visualized by preoperative lymphoscintigraphy in 99% of all patients (502/506): axillary SLNs in 499 patients (99%), ipsilateral IM LNs in 109 patients (22%). In 85 patients with visualized IM SLNs the IM nodes could be removed (78%). In 20 of the latter 85 patients IM SLNs contained metastases (24%). IM metastases were associated with axillary LN metastases (P < 0.001). In 17 patients IM metastases led to extension of the radiotherapy field, while additional (adjuvant) systemic therapy was given in six patients. Conclusion SLNs in the IM chain are common in breast cancer patients and can be extirpated in the majority of these patients. The proportion of patients in whom radiotherapeutic treatment was adjusted due to IM LN metastases was substantial. We advocate retrieval of IM SLNs when visualized by preoperative lymphoscintigraphy.
Collapse
Affiliation(s)
- EVE Madsen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - PD Gobardhan
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - V Bongers
- Department of Nuclear Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - M Albregts
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - JPJ Burgmans
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - P De Hooge
- Department of Nuclear Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - J Van Gorp
- Department of Pathology, Diakonessenhuis, Utrecht, The Netherlands
| | - Th van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
- Bosboomstraat 1, 3582 KE Utrecht, The Netherlands
| |
Collapse
|
36
|
Tanaka C, Fujii H, Ikeda T, Jinno H, Nakahara T, Suzuki T, Kitagawa Y, Kitajima M, Ando Y, Kubo A. Stereoscopic scintigraphic imaging of breast cancer sentinel lymph nodes. Breast Cancer 2007; 14:92-9. [PMID: 17245002 DOI: 10.2325/jbcs.14.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymphoscintigraphy is used preoperatively to identify sentinel lymph nodes (SLNs). Conventional planar scintigraphy cannot provide three-dimensional(3D) information for SLN biopsy. We applied stereoscopic imaging to preoperative lymphoscintigraphy to obtain 3D information and evaluated its usefulness. METHODS Forty-four clinical stage I breast cancer patients (1 male, 43 females; age, 59.4+/-11.4 years) were enrolled in this study. Three hours after the injection of Tc-99m, 10 degrees of oblique images and routine anterior and lateral images were acquired. Anterior and lateral stereoscopic images were obtained in all studies, except for 2 patients; only lateral views were done for those. Two experienced radiologists enumerated the visualized hot nodes. RESULTS Stereoscopic imaging delineated more hot axillary lymph nodes compared to routine planar imaging in 8 of 42 patients (19.0%) on anterior view, 5 of 44 patients (11.4%) on lateral view, and 11 of 44 patients (25.0%) on either the anterior or lateral view. Statistically significant differences were observed between stereoscopic and routine planar imaging method on the anterior (p=0.012) and the lateral views (p=0.043). The stereoscopic imaging provided 3D information and effectively separated closely located hot nodes that were viewed as one hot node on conventional planar images. Thirty-eight out of 42 cases (90%) with anterior stereoscopic images identified the same number or more axillary hot nodes compared with lateral stereoscopic images. CONCLUSION The stereoscopic imaging method could improve the preoperative identification of SLNs. This method is technically simple, and could be a powerful diagnostic tool for SLN imaging breast cancer.
Collapse
Affiliation(s)
- Chikako Tanaka
- Department of Radiology, Keio University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Povoski SP, Olsen JO, Young DC, Clarke J, Burak WE, Walker MJ, Carson WE, Yee LD, Agnese DM, Pozderac RV, Hall NC, Farrar WB. Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer. Ann Surg Oncol 2006; 13:1412-21. [PMID: 16957969 DOI: 10.1245/s10434-006-9022-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 05/23/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple injection routes, including intradermal (ID), intraparenchymal (IP), and subareolar (SA), are used for 99mTc-sulfur colloid administration for sentinel lymph node (SLN) mapping and biopsy in breast cancer. The aim of this study was to compare localization by ID, IP, and SA injection routes based on preoperative lymphoscintigraphy and intraoperative identification. METHODS Four hundred prospectively randomized breast cancers underwent SLN mapping and biopsy. RESULTS Preoperative lymphoscintigraphy demonstrated localization to the axilla in 126/133 (95%) ID, 82/132 (62%) IP, and 96/133 (72%) SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.081 IP vs. SA), with a mean duration of preoperative lymphoscintigraphy of 139 +/- 18 minutes. Mean time to first localization when localization was demonstrated on preoperative lymphoscintigraphy was 8 +/- 14 minutes for ID, 53 +/- 49 for IP, and 22 +/- 29 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.003 IP vs. SA). Intraoperative identification of a SLN at the time of SLN biopsy was successful in 133/133 (100%) ID, 121/134 (90%) IP, and 126/133 (95%) SA (P < 0.001 ID vs IP; P = 0.014 ID vs. SA; P = 0.168 IP vs. SA), with a mean time from injection of 99mTc-sulfur colloid to start of SLN biopsy of 288 +/- 71 minutes. Mean intraoperative time to harvest the first SLN was 9 +/- 4 minutes for ID, 13 +/- 6 for IP, and 12 +/- 6 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.410 IP vs. SA). CONCLUSIONS The ID injection route demonstrated a significantly greater frequency of localization, decreased time to first localization on preoperative lymphoscintigraphy, and decreased time to harvest the first SLN. This represents the first prospective randomized clinical trial to confirm superiority of the ID route for administration of 99mTc-sulfur colloid during SLN mapping and biopsy in breast cancer.
Collapse
Affiliation(s)
- Stephen P Povoski
- Section of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Kim S, Youssef I, Kim CK, Machac J, Krynyckyi BR. Prominent Lymphatic Channels Simulating Sentinel Nodes: The Use of Standing and Delayed Views in Delineating the True Number and Position of Nodes and the Implications for Further Morbidity Reduction. Clin Nucl Med 2005; 30:794-6. [PMID: 16319635 DOI: 10.1097/01.rlu.0000187496.54900.a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Susanne Kim
- Department of Radiology, Division of Nuclear Medicine, Mt. Sinai School of Medicine, New York, NY 10029-6574, USA
| | | | | | | | | |
Collapse
|
39
|
Krynyckyi BR, Shafir MK, Kim SC, Kim DW, Travis A, Moadel RM, Kim CK. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:25. [PMID: 16277655 PMCID: PMC1308847 DOI: 10.1186/1477-7800-2-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 12/28/2022]
Abstract
Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).
Collapse
Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Michail K Shafir
- Department of Surgery, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Dong Wook Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Arlene Travis
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Renee M Moadel
- Department of Nuclear Medicine, Albert Einstein College of Medicine of Yeshiva University, and the Montefiore Medical Center, Bronx, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
40
|
Krynyckyi BR, Singh G, Colon D, Kim CK, Travis A, Kim SC, Machac J. Training simulator for sentinel node biopsy (SLNB). Eur J Surg Oncol 2005; 31:805-6. [PMID: 15975758 DOI: 10.1016/j.ejso.2005.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/22/2005] [Indexed: 11/24/2022] Open
|
41
|
Kim SC, Kim DW, Moadel RM, Kim CK, Chatterjee S, Shafir MK, Travis A, Machac J, Krynyckyi BR. Using the intraoperative hand held probe without lymphoscintigraphy or using only dye correlates with higher sensory morbidity following sentinel lymph node biopsy in breast cancer: a review of the literature. World J Surg Oncol 2005; 3:64. [PMID: 16194276 PMCID: PMC1262786 DOI: 10.1186/1477-7819-3-64] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 09/29/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are no studies that have directly investigated the incremental reduction in sensory morbidity that lymphoscintigraphy images (LS) and triangulated body marking or other skin marking techniques provide during sentinel lymph node biopsy (SLNB) compared to using only the probe without LS and skin marking or using only dye. However, an indirect assessment of this potential for additional sensory morbidity reduction is possible by extracting morbidity data from studies comparing the morbidity of SLNB to that of axillary lymph node dissection. METHODS A literature search yielded 13 articles that had data on sensory morbidity at specific time points on pain, numbness or paresthesia from SLNB that used radiotracer and probe or used only dye as a primary method of finding the sentinel node (SN). Of these, 10 utilized LS, while 3 did not utilize LS. By matching the data in studies not employing LS to the studies that did, comparisons regarding the percentage of patients experiencing pain, numbness/paresthesia after SLNB could be reasonably attempted at a cutoff of 9 months. RESULTS In the 7 studies reporting on pain after 9 months (> 9 months) that used LS (1347 patients), 13.8% of patients reported these symptoms, while in the one study that did not use LS (143 patients), 28.7% of patients reported these symptoms at > 9 months (P < 0.0001). In the 6 studies reporting on numbness and/or paresthesia at > 9 months that used LS (601 patients), 12.5% of patients reported these symptoms, while in the 3 studies that did not use LS (229 patients), 23.1% of patients reported these symptoms at > 9 months (P = 0.0002). Similar trends were also noted for all these symptoms at < or = 9 months. CONCLUSION Because of variations in techniques and time of assessing morbidity, direct comparisons between studies are difficult. Nevertheless at a minimum, a clear trend is present: having the LS images and skin markings to assist during SLNB appears to yield more favorable morbidity outcomes for the patients compared to performing SLNB with only the probe or performing SLNB with dye alone. These results are extremely pertinent, as the main reason for performing SLNB itself in the first place is to achieve reduced morbidity.
Collapse
Affiliation(s)
- Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Dong Wook Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Renee M Moadel
- Department of Nuclear Medicine, Albert Einstein College of Medicine of Yeshiva University, and the Montefiore Medical Center, Bronx, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Samprit Chatterjee
- Department of Health Policy, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Michail K Shafir
- Department of Surgery, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Arlene Travis
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Josef Machac
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
42
|
Krynyckyi BR, Sata S, Zolty I, Kim DW, Kim SC, Knesaurek K. Sentinel node detection in patients with breast cancer: low-energy all-purpose collimator or medium-energy collimator? Clin Nucl Med 2005; 30:369-70; author reply 370. [PMID: 15827421 DOI: 10.1097/01.rlu.0000159913.08107.5b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Krynyckyi BR, Kim SC, Kim CK. Preoperative lymphoscintigraphy and triangulated patient body marking are important parts of the sentinel node process in breast cancer. World J Surg Oncol 2005; 3:56. [PMID: 16120218 PMCID: PMC1215530 DOI: 10.1186/1477-7819-3-56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 08/24/2005] [Indexed: 11/11/2022] Open
Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
44
|
Kim S, Krynyckyi BR, Fedorciw BJ, Kim CK. Extremely indirect dermal lymphatic channels: value of areolar-cutaneous junction injection technique for breast lymphoscintigraphy. ACTA ACUST UNITED AC 2005; 62:335-7. [PMID: 15890219 DOI: 10.1016/j.cursur.2004.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This case describes a patient who initially had peri-excisional injections of radiocolloid around a lumpectomy site that failed to visualize sentinel nodes during lymphoscintigraphy. After additional areolar-cutaneous junction injections, extremely indirect dermal lymphatic pathways were evident with resultant drainage to two sentinel nodes, both of which contained disease. Hybrid combination injections of radiotracer during sentinel lymph node biopsy is gaining in popularity. This case illustrates the validity of the hybrid injection techniques and the demonstrated accuracy despite seemingly disconnected and extremely tortuous pathways as demonstrated in the figure.
Collapse
Affiliation(s)
- SunHee Kim
- Division of Nuclear Medicine, Department of Radiology, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA
| | | | | | | |
Collapse
|
45
|
Zavagno G, Rubello D, Franchini Z, Meggiolaro F, Ballarin A, Casara D, Denetto V, Marchet A, Rampin L, Polico C, Nitti D, Mariani G. Axillary sentinel lymph nodes in breast cancer: a single lymphatic pathway drains the entire mammary gland. Eur J Surg Oncol 2005; 31:479-84. [PMID: 15922882 DOI: 10.1016/j.ejso.2005.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2005] [Indexed: 11/19/2022] Open
Abstract
AIM To report the pattern of lymphatic mapping following intrasubdermal injections of radiocolloid and of blue dye in different sites of the breast. METHODS Prior to surgery 137 breast cancer patients underwent intrasubdermal injection of 30-50 MBq 99mTc-colloidal albumin over the tumour site (ISI group). Ten minutes before surgery, 2 ml patent blue was injected in the subareolar area (SAI group) in 117/137 patients, while 20 patients received intrasubdermal blue-dye in the quadrant opposite the tumour site (OQI group). The different injection routes were considered concordant when the hottest sLN was also blue. RESULTS In 134/137 patients radiocolloid drained to one or more axillary nodes, while blue nodes were found in 98/117 SAI patients and in 17/20 OQI patients. Multiple hot nodes were found in 63/134 cases and multiple blue nodes in 35/115. In patients in whom both tracers reached the axilla, the hottest node was also blue in 108/115 cases (93/98 SAI and 15/17 OQI patients). In the seven discordant cases, the hottest node was not blue, but in two cases the blue node was also radioactive. CONCLUSIONS Superficial lymphatic drainage from the breast most frequently merges to a single axillary lymph node, irrespective of the site of tracer injection. In a few cases different injection sites identify different, often closely interconnected sLNs.
Collapse
Affiliation(s)
- G Zavagno
- Department of Oncological and Surgical Sciences, University of Padua Medical School, Padua, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Kim SH, Shim J, Kim CK, Machac J, Krynyckyi BR. Reverse echelon node and a lymphatic ectasia in the same patient during breast lymphoscintigraphy: the importance of injection and imaging technique. Br J Radiol 2005; 77:1053-6. [PMID: 15569651 DOI: 10.1259/bjr/65044256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lymphoscintigraphy, along with triangulated patient body marking, can serve as a guide for surgeons during sentinel lymph node harvesting. Unique drainage patterns have been noted, especially with areolar or intradermal based injections, which are becoming increasingly popular. The images lymphoscintigraphy provide have been invaluable in delineating these patterns. The authors present a case that simultaneously illustrates two separate points in the same patient, a reverse echelon node and a lymphatic ectasia. To our knowledge, this combination has never been described in the same patient. Perilesional and areolar-cutaneous junction injections were performed sequentially and generated these patterns that could potentially have resulted in added morbidity and a false-negative sentinel node if not realised before surgery. Lymphoscintigraphy added valuable information in the management of this patient, which can occasionally present with complex patterns of activity during sentinel node harvesting.
Collapse
Affiliation(s)
- S H Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA
| | | | | | | | | |
Collapse
|
47
|
Kim S, Kim CK, Krynyckyi BR. Areolar-Cutaneous Junction Injection Boosts Activity in Sentinel Node by More than 50 Times Compared to Perilesional Injection: Implications for Morbidity Reduction. Am Surg 2005. [DOI: 10.1177/000313480507100115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The combination of concurrently administered perilesional radiotracer injections and areolar-cutaneous junction radiotracer injections during one imaging session in the detection of sentinel nodes (SN) in breast cancer is new. A case is presented where the perilesional injections of radiotracer produced a faint node. Subsequently, 45 minutes later, the same patient received an injection of radiotracer at the areolar-cutaneous junction, which “boosted” the activity in the original SN by more than 50 times. This case illustrates the marked improvement in SN counts that can occur with the addition of areolar-cutaneous junction injections to perilesional injections. The perilesional component of this hybrid injection technique maintains the ability to visualize internal mammary and extra-axillary SN. Even more importantly, these “hotter” nodes have significant implications for morbidity reduction, the main goal of sentinel lymph node biopsy in itself.
Collapse
Affiliation(s)
- Sunhee Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, New York, New York
| | - Chun K. Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, New York, New York
| | - Borys R. Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, New York, New York
| |
Collapse
|
48
|
Sata S, Knesaurek K, Krynyckyi BR. Effective dose in sentinel lymph node imaging. Br J Radiol 2004; 77:709; author reply 709. [PMID: 15326057 DOI: 10.1259/bjr/18430562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
49
|
Lim I, Shim J, Goyenechea M, Kim CK, Krynyckyi BR. Drainage Across Midline to Sentinel Nodes in the Contralateral Axilla in Breast Cancer. Clin Nucl Med 2004; 29:346-7. [PMID: 15166879 DOI: 10.1097/01.rlu.0000127087.12686.81] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors report a case of recurrent breast carcinoma in the right chest in a patient who earlier had a right breast mastectomy. Injection of Tc-99m sulfur colloid into the lesion site in the right midchest revealed drainage to a very faint node in the contralateral axilla on the left, an unexpected site, and none to the ipsilateral axilla, the expected site. Disease was found in the left axilla in the sentinel nodes. Lymphoscintigraphy added valuable information in the management of this patient.
Collapse
Affiliation(s)
- Ilhan Lim
- Division of Nuclear Medicine, Department of Radiology, The Mount Sinai School of Medicine, New York, New York 10029, USA
| | | | | | | | | |
Collapse
|
50
|
Krynyckyi BR, Shim J, Lim I. Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for Stage I or II breast carcinoma. Cancer 2004; 100:654-5; author reply 655-6. [PMID: 14745886 DOI: 10.1002/cncr.11946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|