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Related Experiment Videos

The hidden sentinel node in breast cancer.

P J Tanis1, J W van Sandick, O E Nieweg

  • 1Department of Surgery, The Netherlands Cancer Institute, Amsterdam. ptanis@nki.nl

European Journal of Nuclear Medicine and Molecular Imaging
|May 11, 2002
PubMed
Summary

Preoperative lymphoscintigraphy for breast cancer sentinel node identification achieved a 90% visualization rate, improving with experience. Factors like patient age and tracer dose influenced non-visualization, with delayed imaging and re-injection enhancing detection success.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Surgical Oncology

Background:

  • Sentinel lymph node biopsy is crucial for breast cancer staging.
  • Preoperative lymphoscintigraphy aids in identifying the sentinel node.
  • Non-visualization of the sentinel node can complicate surgical planning.

Purpose of the Study:

  • To analyze the occurrence of non-visualization during preoperative lymphoscintigraphy for sentinel node identification in breast cancer.
  • To identify factors associated with scintigraphic non-visualization.
  • To evaluate methods for improving sentinel node visualization rates.

Main Methods:

  • Preoperative lymphoscintigraphy using technetium-99m nanocolloid in 495 clinically node-negative breast cancer patients.
  • Anterior and prone lateral planar imaging at early and 4-hour post-injection time points.

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  • Intraoperative identification using patent blue dye and a gamma-ray detection probe.
  • Analysis of delayed imaging and repeat injections for non-visualized nodes.

    • Main Results:

    • A sentinel node was visualized on 4-hour images in 90% of procedures, improving from 76% to 94% over the study period.
    • Delayed imaging and repeat injections increased the overall visualization rate to 92%.
    • Scintigraphic non-visualization was independently associated with increased patient age, decreased tracer dose, and a higher number of tumor-positive lymph nodes.

    Conclusions:

    • Sufficient radiotracer dose (≥100 MBq) is recommended for lymphatic mapping in breast cancer, particularly in elderly patients.
    • Delayed imaging and re-injection strategies can improve sentinel node visualization rates.
    • Non-visualized sentinel nodes can be identified intraoperatively in over half of patients.