Iranian Journal of Nuclear Medicine

Iranian Journal of Nuclear Medicine

Dynamic lymphoscintigraphy in breast cancer patients: feasibility and added value

Document Type : Original Article

Authors
Leili Zarifmahmoudi 1
Hossein Shabahang 2
Farzaneh Shariati 1
Vahid Reza Dabbagh Kakhki 1
Mostafa Mehrabibahar 3
Roya Sadat Alavifard 1
Ali Jangjoo 3
Ramin Sadeghi 1
1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Endoscopic & Minimally Invasive Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Introduction: Lymphoscintigraphy is imaging of the lymphatic system and has been integrated into the sentinel node mapping procedures. Lymphoscintigraphy usually encompasses early or delayed static images. However, immediate dynamic imaging of the lymphatic basins and tumors has also been used as an adjunct lymphoscintigraphy imaging. The aim of this study was to assess the role of early dynamic acquisition versus static lymphoscintigraphy images for sentinel node detection in breast cancer.
Methods:Seventy five women with proved breast cancer and clinically node negative axilla entered the study. For each patient 0.5 mCi Tc-99m-antimony sulfide colloid in the 0.2 cc volume was injected in periareolar region in an intradermal fashion. Immediately after injection dynamic imaging was started as 1 minute per frame for 15 minutes. Static anterior and lateral images (5min/image) was also taken 30 minutes post injection. Imaging data for each patient were evaluated blindly by two experienced nuclear physicians and early dynamic imaging data were assessed for its value in detection of sentinel nodes.
Results:Overall 75 patients entered the current study. Sentinel node(s) could be identified on the dynamic lymphoscintigraphy images in 65 patients (86.6%). In 4 patients, dynamic lymphoscintigraphy could differentiate the second visible sentinel nodes as second echelon or true sentinel nodes.
Conclusion: Dynamic lymphoscintigraphy immediately after radiotracer injection is feasible in breast cancer patients with a high detection rate. The added value of dynamic over delayed static imaging is the ability to differentiate between second echelon and secondary sentinel nodes.
Keywords
Breast cancer
Lymphoscintigraphy
Dynamic
Second echelon nodes
Second tier nodes
Subjects
  1. Nathanson SD, Grogan JK, DeBruyn D, Kapke A, Karvelis K. Breast cancer sentinel lymph node identification rates: the influence of radiocolloid mapping, case volume, and the place of the procedure. Ann Surg Oncol. 2007 May;14(5):1629-37.
  2. Newman EA, Newman LA. Lymphatic mapping techniques and sentinel lymph node biopsy in breast cancer. Surg Clin North Am. 2007 Apr;87(2):353-64, viii.
  3. Newman LA. Lymphatic mapping and sentinel lymph node biopsy in breast cancer patients: a comprehensive review of variations in performance and technique. J Am Coll Surg. 2004 Nov;199(5):804-16.
  4. Kadkhodayan S, Hasanzadeh M, Treglia G, Azad A, Yousefi Z, Zarifmahmoudi L, Sadeghi R. Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature. Eur J Surg Oncol. 2015 Jan;41(1):1-20.
  5. Sadeghi R, Alesheikh G, Zakavi SR, Fattahi A, Abdollahi A, Assadi M, Jangjoo A, Keshtgar M. Added value of blue dye injection in sentinel node biopsy of breast cancer patients: do all patients need blue dye? Int J Surg. 2014;12(4):325-8.
  6. Hassanzade M, Attaran M, Treglia G, Yousefi Z, Sadeghi R. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol. 2013 Jul;130(1):237-45.
  7. Ansari M, Rad MA, Hassanzadeh M, Gholami H, Yousefi Z, Dabbagh VR, Sadeghi R. Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature. Eur J Gynaecol Oncol. 2013;34(5):387-401.
  8. Sadeghi R, Gholami H, Zakavi SR, Kakhki VR, Tabasi KT, Horenblas S. Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature. J Urol. 2012 Jan;187(1):25-31.
  9. Sadeghi R, Tabasi KT, Bazaz SM, Kakhki VR, Massoom AF, Gholami H, Zakavi SR. Sentinel node mapping in the prostate cancer. Meta-analysis. Nuklearmedizin. 2011;50(3):107-15.
  10. Lawson LL, Sandler M, Martin W, Beauchamp RD, Kelley MC. Preoperative lymphoscintigraphy and internal mammary sentinel lymph node biopsy do not enhance the accuracy of lymphatic mapping for breast cancer. Am Surg. 2004 Dec;70(12):1050-5; discussion 1055-6.
  11. Sadeghi R, Forghani MN, Memar B, Abdollahi A, Zakavi SR, Mashhadi MT, Raziee HR, Tavassoli A, Kakhki VR. Comparison of pre-operative lymphoscintigraphy with inter-operative gamma probe and dye technique regarding the number of detected sentinel lymph nodes. Hell J Nucl Med. 2009 Jan-Apr;12(1):30-2.
  12. Eldrageely K, Vargas MP, Khalkhali I, Venegas R, Burla M, Gonzalez KD, Vargas HI. Sentinel lymph node mapping of breast cancer: a case-control study of methylene blue tracer compared to isosulfan blue. Am Surg. 2004 Oct;70(10):872-5.
  13. Sadeghi R, Asadi M, Treglia G, Zakavi SR, Fattahi A, Krag DN. Determining axillary concordance rate for different injection locations in sentinel node mapping of breast cancer: how ambitious can we get? Breast Cancer Res Treat. 2014 Jul;146(1):231-2.
  14. Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Reza Dabbagh Kakhki V, Aryana K, Forghani MN, Sadeghi R. Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. Am J Surg. 2011 Aug;202(2):199-202.
  15. Dabbagh Kakhki VR, Jangjoo A, Tavassoli A, Asadi M, Sadri K, Fatahi Masoom A, Mehrabibahar M, Memar B, Ansari M, Sadeghi R. Sentinel node mapping for early breast cancer patients using 99mTc-phytate: Single center experience on 165 patients. Iran J Nucl Med 2012;20(2):25-9.
  16. Jangjoo A, Forghani MN, Mehrabibahar M, Rezapanah A, Kakhki VR, Zakavi SR, Ghavamnasiri MR, Kashani I, Hashemian F, Sadeghi R. Comparison of early and delayed lymphoscintigraphy images of early breast cancer patients undergoing sentinel node mapping. Nucl Med Commun. 2010 Jun;31(6):521-5.
  17. Miura H, Ono S, Shibutani K, Seino H, Tsushima F, Kakehata S, Hirose K, Fujita H, Kakuta A, Aoki M, Hatayma Y, Kawaguchi H, Sato M, Takai Y, Kaneko T, Sawamura D. Contribution of dynamic sentinel lymphoscintigraphy images to the diagnosis of patients with malignant skin neoplasms in the upper and lower extremities. Springerplus. 2014 Oct 22;3:625.
  18. Martínez-Rodríguez I, De Arcocha Torres M, Banzo I, Quirce R, Jiménez-Bonilla J, Medina-Quiroz P, Rubio-Vassallo A, Del Castillo R, Carril JM. Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer. Q J Nucl Med Mol Imaging. 2013 Sep;57(3):296-300.
  19. Petersen LJ, Pedersen RD, Skindhøj S, Hasseriis S, Hvid HM. Early dynamic versus late static lymphoscintigraphy for the identification of sentinel lymph nodes in breast cancer. Clin Nucl Med. 2011 Dec;36(12):1098-101.
  20. Nakashima K, Kurebayashi J, Sonoo H, Tanaka K, Ikeda M, Shiiki S, Yamamoto Y, Nomura T, Sohda M, Seki M, Miyake A, Moriya T, Sadahira Y, Mimura H, Fukunaga M. Preoperative dynamic lymphoscintigraphy predicts sentinel lymph node metastasis in patients with early breast cancer. Breast Cancer. 2010;17(1):17-21.
  21. Toubert ME, Just PA, Baillet G, Kerob D, Hindie E, Verola O, Revol M, Servant JM, Basset-Seguin N, Lebbe C, Banti E, Rubello D, Moretti JL. Slow dynamic lymphoscintigraphy is not a reliable predictor of sentinel-node negativity in cutaneous melanoma. Cancer Biother Radiopharm. 2008;23 (4):443-50.
  22. Doting MH, Stiekema HM, de Vries J, Lemstra C, Hoekstra HJ, Vrieling M, Rietman L, Jager PL. Immediate dynamic lymphoscintigraphy delivers no additional value to lymphoscintigraphy 3 hr after tracer injection in sentinel lymph node biopsy in breast cancer patients. J Surg Oncol. 2007 May 1;95(6):469-75.
  23. Chen YW, Chuang YW, Lai YC, Hsieh JS, Liu GC, Hou MF. Is early dynamic lymphoscintigraphy for detection of sentinel lymph nodes always achievable in breast tumor? Ann Nucl Med. 2006 Jan;20(1):45-50.
  24. Kretschmer L, Altenvoerde G, Meller J, Zutt M, Funke M, Neumann C, Becker W. Dynamic lymphoscintigraphy and image fusion of SPECT and pelvic CT-scans allow mapping of aberrant pelvic sentinel lymph nodes in malignant melanoma. Eur J Cancer. 2003 Jan;39(2):175-83.
  25. Momennezhad M, Zakavi SR, Dabbagh Kakhki VR, Jangjoo A, Ghavamnasiri MR, Sadeghi R. Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source. Radiol Oncol. 2011 Sep;45(3):184-8.
  26. Hubalewska-Dydejczyk A, Sowa-Staszczak A, Huszno B. Current application of sentinel lymph node lymphoscintigraphy to detect various cancer metastases. Hell J Nucl Med. 2006 Jan-Apr;9(1):5-9.
  27. Taylor A Jr, Murray D, Herda S, Vansant J, Alazraki N. Dynamic lymphoscintigraphy to identify the sentinel and satellite nodes. Clin Nucl Med. 1996 Oct;21(10):755-8.
  28. Tartaglione G, Vigili MG, Rahimi S, Celebrini A, Pagan M, Lauro L, Al-Nahhas A, Rubello D. The impact of superficial injections of radiocolloids and dynamic lymphoscintigraphy on sentinel node identification in oral cavity cancer: a same-day protocol. Nucl Med Commun. 2008 Apr;29(4):318-22.
  29. Nieweg OE, Tanis PJ, Kroon BB. The definition of a sentinel node. Ann Surg Oncol. 2001 Jul;8(6):538-41.
  30. Uren RF, Howman-Giles RB, Thompson JF. Demonstration of second-tier lymph nodes during preoperative lymphoscintigraphy for melanoma: incidence varies with primary tumor site. Ann Surg Oncol. 1998 Sep;5(6):517-21.
  31. Morton DL, Bostick PJ. Will the true sentinel node please stand? Ann Surg Oncol. 1999 Jan-Feb;6(1):12-4.
  32. Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, Ku NN, Lyman GH, Berman C, Haddad F, Reintgen DS. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998 May;227(5):645-51; discussion 651-3.
  33. Sadeghi R, Forghani MN, Memar B, Rajabi Mashhadi MT, Dabbagh Kakhki VR, Abdollahi A, Zakavi SR. How long the lymphoscintigraphy imaging should be continued for sentinel lymph node mapping? Ann Nucl Med. 2009 Aug;23(6):507-10.
  34. Abdollahi A, Jangjoo A, Dabbagh Kakhki VR, Rasoul Zakavi S, Memar B, Naser Forghani M, Mehrabibahar M, Sadeghi R. Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer. Rev Esp Med Nucl. 2010 Mar-Apr;29(2):73-7.
  35. Sadri K, Ayati NK, Shabani G, Zakavi SR, Sadeghi R. Sentinel node detection failure due to defective labeling and large particle size of Tc-99m antimony sulfide colloid. Iran J Nucl Med 2011;19(1):6-11.
  36. Dabbagh Kakhki VR, Aliakbarian H, Fattahi A, Jangjoo A, Assadi M, Khajeh M, Sadeghi R. Effect of radiotracer injection volume on the success of sentinel node biopsy in early-stage breast cancer patients. Nucl Med Commun. 2013 Jul;34(7):660-3.
  37. Higashi H, Natsugoe S, Uenosono Y, Ehi K, Arigami T, Nakabeppu Y, Nakajo M, Aikou T. Particle size of tin and phytate colloid in sentinel node identification. J Surg Res. 2004 Sep;121(1):1-4.
  38. Tsopelas C. Particle size analysis of (99m)Tc-labeled and unlabeled antimony trisulfide and rhenium sulfide colloids intended for lymphoscintigraphic application. J Nucl Med. 2001 Mar;42(3):460-6.