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99mTc-Tetrofosmin pinhole-SPECT (P-SPECT) and radioguided sentinel node (SN) biopsy and in breast cancer axillary lymph node staging.

Abstract
We compared 99mTc-Tetrofosmin P-SPECT with radioguided SN biopsy in 101 T1/T2 BC pts to predict axillary lymph node status. The day before surgery all pts underwent lymphoscintigraphy (LS) to mark the SN, following subdermal injection of 99mTc-colloidal sulphur surrounding the breast lesion. LS was combined with pre and intraoperative gamma probe. Previously, all pts had also undergone P-SPECT. ALND was performed in all cases. The SN(s) was detected in 97/101 cases (96%) by LS and gamma probe; in the 4 missed cases P-SPECT predicted lymph node status. In the 97 comparable cases, radioguided SN biopsy showed a slightly higher accuracy than P-SPECT (94.8% vs 93.8%), but a higher false-negative rate (14.3% vs 8.6%); P-SPECT had a higher NPV (95.2% vs 92.5%). The two procedures when combined achieved 100% accuracy. Radioguided SN biopsy alone had 100% accuracy only in pts with BC < 15 mm. P-SPECT had 3 false negative cases, 2 of which were micrometastatic SNs, and 3 false positives. P-SPECT identified 81.2% of cases with a single node, determined the exact number of nodes in 82.6% of cases with 1 to 3 node and correctly classified 93.7% of pts as having < or = 3 or > 3 metastatic nodes. Radioguided SN biopsy seems indicated in selected, early stage, small BC pts, while P-SPECT shows a high sensitivity independent of primary tumor size, giving additional important preoperative prognostic information. The two procedures combined provided a better axillary lymph node status prediction in T1/T2 carcinomas, and could thus improve ALND pt selection.
AuthorsA Spanu, G Dettori, F Chessa, A Porcu, P Cottu, P Solinas, A Falchi, M E Solinas, A M Scanu, S Nuvoli, G Madeddu
JournalCancer biotherapy & radiopharmaceuticals (Cancer Biother Radiopharm) Vol. 16 Issue 6 Pg. 501-13 (Dec 2001) ISSN: 1084-9785 [Print] United States
PMID11789027 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • technetium tc-99m tetrofosmin
Topics
  • Adult
  • Aged
  • Axilla (surgery)
  • Biopsy, Needle
  • Breast Neoplasms (diagnostic imaging, pathology)
  • Carcinoma, Ductal, Breast (diagnostic imaging, secondary)
  • Carcinoma, Lobular (diagnostic imaging, secondary)
  • Carcinoma, Medullary (diagnostic imaging, secondary)
  • Female
  • Humans
  • Lymph Node Excision
  • Lymph Nodes (diagnostic imaging)
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Prospective Studies
  • Radiopharmaceuticals
  • Sentinel Lymph Node Biopsy (methods)
  • Tomography, Emission-Computed, Single-Photon (methods)

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