Clinical breast lymphoscintigraphy: optimal techniques for performing studies, image atlas, and analysis of images

Breast lymphoscintigraphy is increasingly performed before surgery to delineate the drainage to the sentinel node (SN) in the axilla. On the basis of the histologic status of harvested SNs, the disease status of the entire axilla can be predicted. This prediction allows a more limited dissection to be performed while maintaining staging accuracy comparable with that of classic axillary lymph node dissection. Lymphoscintigraphy assists surgeons in harvesting the SN during gamma probe-assisted axillary biopsy or dissection and provides a wide field of view survey, among other benefits. When certain injection protocols are used, lymphoscintigraphy can be performed in the afternoon before surgery the next morning, thus minimizing disruptions of tight surgical schedules. Image acquisition can be optimized and SN activity can be maximized by means of such factors as parameters for preparation of the radiotracer, injection techniques, energy settings for the gamma camera, breast displacement maneuvers, and techniques for marking and outlining the patient's body. The ultimate goals are to delineate the true SN, maximize activity in the node for facilitated removal (even at next-day surgery), and deliver the information to the surgeon without delaying the surgical schedule.