Radiotracer re-injection in case of sentinel node non-visualization in a breast cancer patient

Document Type : Case Report

Authors

Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

We reported a 35 year old breast cancer patient who was referred to our nuclear medicine department for sentinel node mapping. She was planned to undergo mastectomy and lymphatic mapping. A dose of Tc-99m Phytate was injection in the peri-areolar region in an intra-dermal fashion. Two hours post-injection no sentinel node was visible in the axilla. Due to a high liver uptake, inadvertent intra-vascular injection was suspected and another dose of the radiotracer was injected in the breast. Lymphoscintigraphy two minutes post-injection showed an axillary sentinel node. Our case underscores the importance of second radiotracer injection in case of sentinel node non-visualization.

Keywords

Main Subjects


  1. 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.
  2. He PS, Li F, Li GH, Guo C, Chen TJ. The combination of blue dye and radioisotope versus radioisotope alone during sentinel lymph node biopsy for breast cancer: a systematic review. BMC Cancer. 2016 Feb 16;16:107.
  3. Niebling MG, Pleijhuis RG, Bastiaannet E, Brouwers AH, van Dam GM, Hoekstra HJ. A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping. Eur J Surg Oncol. 2016 Apr;42(4):466-73.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Ichihara H, Onoguchi M, Kikuchi A, Shibutani T. Evaluation of the subtraction method utilizing posterior view for improving visibility of the sentinel lymph nodes for lymphoscintigraphy in breast cancer. Ann Nucl Med. 2016 May;30(4):298-308.
  9. Vidal M, Vidal-Sicart S, Torres F, Ruiz DM, Paredes P, Pons F. Correlation between theoretical anatomical patterns of lymphatic drainage and lymphoscintigraphy findings during sentinel node detection in head and neck melanomas. Eur J Nucl Med Mol Imaging. 2016 Apr;43(4):626-34.
  10. Meretoja TJ, Joensuu H, Heikkilä PS, Leidenius MH. Safety of sentinel node biopsy in breast cancer patients who receive a second radioisotope injection after visualization failure in lymphoscintigraphy. J Surg Oncol. 2010 Nov 1;102(6):649-55.
  11. Pouw B, Hellingman D, Kieft M, Vogel WV, van Os KJ, Rutgers EJ, Valdés Olmos RA, Stokkel MP. The hidden sentinel node in breast cancer: Reevaluating the role of SPECT/CT and tracer reinjection. Eur J Surg Oncol. 2016 Apr;42(4):497-503.
  12. Ali J, Alireza R, Mostafa M, Naser FM, Bahram M, Ramin S. Comparison between one day and two days protocols for sentinel node mapping of breast cancer patients. Hell J Nucl Med. 2011 Sep-Dec;14(3):313-5.
  13. 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.
  14. 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.
  15. 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.
  16. Jangjoo A, Shabani G, Zakavi R, Dabbagh Kakhki V, Sadeghi R. Disappearance of a sentinel node on the delayed lymphoscintigraphy imaging of a breast cancer patient: Importance of blue dye injection. Nowotwory J Oncol. 2011;61(1):9e-10e.
  17. 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.
  18. Kadkhodayan S, Farahabadi EH, Yousefi Z, Hasanzadeh M, Sadeghi R. Inappropriate Intra-cervical Injection of Radiotracer for Sentinel Lymph Node Mapping in a Uterine Cervix Cancer Patient: Importance of Lymphoscintigraphy and Blue Dye Injection. Asia Ocean J Nucl Med Biol. 2014 Fall;2(2):135-7.