Technical aspects of performing lymphoscintigraphy: optimization of methods used to obtain images

Sentinel node detection is an important part of the clinical management of newly diagnosed melanoma. Now there is a similar or even greater enthusiasm for sentinel node evaluation in patients with breast carcinoma. However, controversies exist regarding the dose, volume, and route of administration. Even the role of lymphoscintigraphy itself, in contrast to using only a hand-held gamma probe during surgery for sentinel node detection, is being debated. Nevertheless, many centers and surgeons find that lymphoscintigraphy images are valuable in the treatment of patients and they use lymphoscintigraphy as a guide during surgery and to confirm the results obtained with the hand-held probe. Centers just beginning to use lymphoscintigraphy may find the images especially useful. Given this fact, the authors wanted to define the practical and technical aspects of performing lymphoscintigraphy in patients with breast cancer and examined various methods for the optimization of the technique of image acquisition. The suggested technique is generally free of the controversies noted above and applies to most patients. It includes various maneuvers that aim to improve the rate of sentinel node visualization using the gamma camera and the accuracy of node detection. The recommendations presented here should prove useful for both those experienced and for those centers just beginning to use the technique of lymphoscintigraphy.