Advertisement

Lymphoscintigraphy and Sentinel Node Localization in Breast Cancer

  • Cornelis A. Hoefnagel
Chapter

Abstract

Breast cancer has always been an important indication for a great variety of nuclear medicine procedures. Lymphoscintigraphy used to play a role in the management of lymphedema of the arm and in locating the internal mammary nodes in the planning of radiation therapy. Lessons were learnt, which are relevant for the current use of the sentinel lymph node biopsy, namely, the great individual variability and the prognostic significance of pathological non-axillary lymph nodes.

The sentinel lymph node biopsy (SLNB) procedure is an important tool in surgical oncology for nodal staging of operable tumors. If the first draining node(s) is/are found to be free of tumor cells, more extensive nodal surgery, which may be associated with additional morbidity and complications, e.g., lymphedema, can be avoided.

However, in order to base the entire treatment policy on the analysis of a single or few lymph node(s), it is imperative that the correct lymph node is identified as the sentinel node. Nuclear medicine plays an essential role in the preoperative mapping of sentinel lymph nodes, which are subsequently resected, guided by an intraoperative gamma probe.

SPECT/CT is of great value for the detection and proper localization of sentinel nodes of breast cancer, especially if it concerns the localization of non-axillary sentinel nodes. It provides the surgeon the anatomical detail needed to approach and resect sentinel nodes. In case of no detection of a sentinel node by planar lymphoscintigraphy, the sentinel node can still be detected by SPECT/CT in half of the cases.

Although PET/CT and PET/MR using 18F-fluorodeoxyglucose (FDG) offer great sensitivity and accuracy for diagnosis, staging, restaging, and response monitoring in breast cancer, the sentinel node biopsy remains the best technique for nodal staging at the microscopic level.

It concluded that the SLNB is an important tool for staging breast cancer at the microscopic level. However, to ensure that the correct lymph node is identified and removed as “sentinel node,” it is imperative that preoperative imaging is optimized by every possible means. SPECT/CT is more sensitive and more accurate than planar lymphoscintigraphy, especially in locating non-axillary sentinel nodes, and this may influence the surgical approach.

Keywords

Emission tomography Lymphoscintigraphy Nodal staging Sentinel node Sentinel lymph node biopsy (SLNB) SPECT/CT Technetium-99m nanocolloid 

References

  1. 1.
    Koolen BB, Vrancken Peeters MJTFD, Aukema TS, et al. 18F-FDG PET/CT as staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques. Breast Cancer Res Treat. 2012;131:117–26.CrossRefPubMedGoogle Scholar
  2. 2.
    Groheux D, Giacchetti S, Espie M, et al. Early monitoring of response to neoadjuvant chemotherapy in breast cancer with 18F-FDG PET/CT: defining a clinical aim. Eur J Nucl Med Mol Imaging. 2011;38:419–25.CrossRefPubMedGoogle Scholar
  3. 3.
    Koolen BB, Vogel WV, Vrancken Peeters MJTFD, et al. Molecular imaging of breast cancer: from whole-body PET/CT to dedicated breast PET. J Oncol. 2012;2012:438647.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Pace L, Nicolai E, Luongo A, et al. Comparison of whole body PET/CT and PET/MRI in breast cancer patients: lesion detection and quatitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues. Eur J Radiol. 2014;83:289–96.CrossRefPubMedGoogle Scholar
  5. 5.
    Hoefnagel CA, Sivro-Prndelj F, Valdés Olmos RA. Lymphoscintigraphy and sentinel node procedures in breast carcinoma: role, techniques and safety aspects. World J Nucl Med. 2002;1:45–54.Google Scholar
  6. 6.
    McNeill G, Witte M, Witte C, et al. Whole-body lymphoscintigraphy: preferred method for initial assessment of the peripheral lymphatic system. Radiology. 1989;172:495–502.CrossRefPubMedGoogle Scholar
  7. 7.
    Vaqueiro M, Gloviczki P, Fisher J, et al. Lymphoscintigraphy in lymphedema: aid to microsurgery. J Nucl Med. 1986;27:1125–30.PubMedGoogle Scholar
  8. 8.
    Perre CI, Hoefnagel CA, Kroon BBR, et al. Altered lymphatic drainage after lymphadenectomy or radiotherapy of the axilla in breast cancer patients: a lymphoscintigraphic study. Br J Surg. 1996;83:1258.CrossRefPubMedGoogle Scholar
  9. 9.
    Haagensen CD. Metastasis of carcinoma of the breast to the periphery of the regional lymph node filter. Ann Surg. 1969;169:174–19.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ege GN. Internal mammary lymphoscintigraphy: a rational adjunct to the staging and management of breast carcinoma. Clin Radiol. 1978;29:453–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Hoefnagel CA, Bartelink H, Heidendal Jeune M, Marcuse HR. Internal mammary lymphoscintigraphy for radiation therapy planning in breast carcinoma. J Eur Radiother. 1982;3:35–42.Google Scholar
  12. 12.
    Ege GN, Elhakim T. The relevance of internal mammary lymphoscintigraphy in the management of breast carcinoma. J Clin Oncol. 1984;7:774–81.CrossRefGoogle Scholar
  13. 13.
    Bourgeois P, Frühling J. Lymphoscintigraphy in adult malignancy. In: Murray IPC, Ell PJ, editors. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. Edinburgh: Churchill Livingstone; 1998. p. 783–90.Google Scholar
  14. 14.
    Cabanas RM. An approach to the treatment of penile carcinoma. Cancer. 1977;39:456–66.CrossRefPubMedGoogle Scholar
  15. 15.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma nodal metastases. Ann Surg. 1994;220:759–67.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nieweg OE, Valdés Olmos RA, Jansen L, et al. Cutaneous lymphoscintigraphy. In: Nieweg E, Reintgen T, editors. Lymphatic mapping and probe applications in cancer. New York: Marcel Dekker; 2000. p. 43–70.Google Scholar
  18. 18.
    Rutgers EJT, Muller SH, Hoefnagel CA. The use of intraoperative probes in surgical oncology. In: Murray IPC, Ell PJ, editors. Nuclear medicine in clinical diagnosis and treatment. 2nd ed. London: Churchill Livingstone; 1998. p. 1025–36.Google Scholar
  19. 19.
    Van Diest PJ, Peterse HJ, Borgstein PJ, et al. Pathological investigation of sentinel lymph nodes. Eur J Nucl Med. 1999;26(suppl):S43–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Guenther JM, Krishnamoorthy M, Tan LR. Sentinel lymphadenectomy for breast cancer in a community managed care setting. Cancer J Sci Am. 1997;3:336–40.PubMedGoogle Scholar
  22. 22.
    Flett MM, Going JJ, Stanton PD, Cooke TG. Sentinel node localization in patients with breast cancer. Br J Surg. 1998;85:991–3.CrossRefPubMedGoogle Scholar
  23. 23.
    Crossin JA, Johnson AC, Stewart PB, Turner WW Jr. Gamma-probe-guided resection of the sentinel node in breast cancer. Am Surg. 1998;64:666–8.PubMedGoogle Scholar
  24. 24.
    Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med. 1998;339:941–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Doting MH, Jansen L, Nieweg OE, et al. Lymphatic mapping with intralesional tracer administration in breast carcinoma patients. Cancer. 2000;88:2546–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227:645–51.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Chatterjee S, Menon M, Drew PJ, et al. Sentinel node biopsy in primary breast cancer: a prospective assessment of two complementary techniques. Eur J Surg Oncol. 1998;24:615–6.Google Scholar
  28. 28.
    Van de Ent FWC, Kengen RAM, Van der Poll HAG, Hoofwijk AGM. Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer. Eur J Surg Oncol. 1999;25:24–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Uren RF, Hoefnagel CA. Lymphoscintigraphy. In: Thompson JF, Morton DL, Kroon BBR, editors. Melanoma. London: Martin Dunitz; 2004. p. 339–64.Google Scholar
  30. 30.
    Alazraki NP, Grant S, Styblo T, et al. Peritumoral (PT) vs subdermal (SD) injection methods for sentinel lymph node (SLN) imaging and intraoperative localization using 2 filtration sizes. J Nucl Med. 2000;41:71. (abstr)Google Scholar
  31. 31.
    Tanis PJ, Nieweg OE, Valdés Olmos RA, et al. Impact of non-axillary sentinel node biopsy on staging and treatment of breast cancer patients. Br J Cancer. 2002;87:705–10.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Estourgie SH, Valdés Olmos RA, Nieweg OE, et al. Lymphatic drainage patterns from the breast. Ann Surg. 2004;239:232–7.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Valdés Olmos RA, Jansen L, Hoefnagel CA, et al. Evaluation of mammary lymphoscintigraphy by single intratumoral injection for sentinel node identification. J Nucl Med. 2000;41:1500–6.PubMedGoogle Scholar
  34. 34.
    Valdés Olmos RA, Tanis PJ, Hoefnagel CA, et al. Improved sentinel node visualization in breast cancer by optimizing the colloid particle concentration and tracer dose. Nucl Med Commun. 2001;22:579–86.CrossRefPubMedGoogle Scholar
  35. 35.
    Tanis PJ, Deurloo EE, Valdés Olmos RA, et al. Single intralesional tracer dose for radioguided excision of clinically occult breast cancer and sentinel node. Ann Surg Oncol. 2001;8:850–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Feggi L, Basaglia E, Corcione S, et al. An original approach in the diagnosis of early breast cancer: use of the same radiopharmaceutical for both non-palpable lesions and sentinel node localisation. Eur J Nucl Med. 2001;28:1589–96.CrossRefPubMedGoogle Scholar
  37. 37.
    Luini A, Zurrida S, Paganelli G, et al. Comparison of radioguided excision with wire localization in occult breast lesion. Br J Surg. 1999;86:522–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Veit-Haibach P, Beyer T. State-of-the-art SPECT/CT: technology, methodology and applications. Eur J Nucl Med Mol Imaging. 2014;41(Suppl 1):S1–S149.PubMedGoogle Scholar
  39. 39.
    Van der Ploeg IMC, Valdes Olmos RA, Nieweg OE, et al. The additional value of SPECT/CT in lymphatic mapping in breast cancer and melanoma. J Nucl Med. 2007;48:1756–60.CrossRefPubMedGoogle Scholar
  40. 40.
    Reintgen D, Albertini J, Milliotes G, et al. Investment in new technology research can save future health care dollars. J Fla Med Assoc. 1997;84:175–81.PubMedGoogle Scholar
  41. 41.
    Gemignani ML, Cody HS 3rd, Fey JV, et al. Impact of sentinel lymph node mapping on relative charges in patients with early-stage breast cancer. Ann Surg Oncol. 2000;7:575–80.CrossRefPubMedGoogle Scholar
  42. 42.
    Jansen L, Muller SH, Nieweg OE, et al Uptake of radiocolloid in sentinel lymph nodes. In: Jansen L. Sentinel Node Biopsy, evolving from melanoma to breast cancer, Thesis, University of Amsterdam 1999. pp 151–168.Google Scholar
  43. 43.
    Miner TJ, Shriver CD, Flicek PR, et al. Guidelines for the safe use of radioactive materials during localization and resection of the sentinel lymph node. Ann Surg Oncol. 1999;6:75–82.CrossRefPubMedGoogle Scholar
  44. 44.
    Persijn K, de Geest E. Sentinel node method: radiological protection. Tijdschr Nucl Geneesk. 2000;20:62. (abstract)Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nuclear Medicine Consultant, Fazantstraat 381171 HS BadhoevedorpThe Netherlands

Personalised recommendations