Comparison between single photon emission computed tomography with computed tomography and planar scintigraphy in sentin
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ORIGINAL ARTICLE
Comparison between single photon emission computed tomography with computed tomography and planar scintigraphy in sentinel node biopsy in breast cancer patients Mitsuru Koizumi1 · Masamichi Koyama1 Received: 7 September 2018 / Accepted: 6 November 2018 / Published online: 19 November 2018 © The Author(s) 2018
Abstract Objective Radio-guided sentinel node (SN) biopsy is a standard method used in the treatment of early breast cancer. Single photon emission computed tomography with computed tomography (SPECT/CT) has been commonly used for SN detection. SPECT/CT adds precise anatomical information of SN sites, and it is reported that more SNs may be detectable on SPECT/CT than on planar imaging. We here investigate which breast cancer patients have benefited from SPECT/CT over planar imaging. Methods A total of 273 breast cancer patients including 80 with ipsilateral breast tumor relapse (IBTR) underwent both multiple-view planar imaging and SPECT/CT for SN detection. The number of SNs, the patients who had benefitted from SPECT/CT, and the SN procedure failure rate were compared between SPECT/CT and planar imaging. Factors influencing the visualization of para-sternal and ipsilateral level II, III nodes, and contralateral axillary nodes were also analyzed using logistic regression analysis. Results The number of hot spots did not differ between SPECT/CT and multiple-view planar imaging. Eight contaminated patients and 52 patients with visualized extra-level I axillary nodes benefited from identifying precise anatomical sites. Even though radioactive nodes could be harvested in most (192/193) of the non-IBTR patients (7/8 in non-SN visible patients), no radioactive nodes could be found during surgery in 11 of 80 IBTR patients. Axillary surgery (dissection) increased the visualization of para-sternal and level II, III axillary nodes, and previous irradiation increased the visualization of contralateral axillary nodes. Conclusion Multiple-view planar imaging was equivalent to SPECT/CT for depicting hot nodes for radio-guided SN detection in breast cancer. SPECT/CT was useful when precise anatomical information was necessary, especially regarding sentinel lymph nodes other than ipsilateral axilla. Logistic regression analysis revealed that axillary surgery (dissection) increased the visualization of para-sternal and level II, III axillary nodes, and the only relevant factor influencing visualization of contralateral axillary SNs was previous radiation to the breast. Keywords Breast cancer · Radio-guided · Sentinel node detection · SPECT/CT · Planar scintigraphy · Contra-axilla visualization
Introduction Radio-guided sentinel node (SN) biopsy is a standard method in the treatment of patients with early breast cancer [1–3]. Single photon emission computed tomography * Mitsuru Koizumi [email protected] 1
Departments of Nuclear Medicine, Cancer Institute Hospital, 3‑8‑31 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
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with computed tomography (SPECT/CT) has been used to detect hot
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