Sentinel node biopsy is a minimally invasive surgery performed on breast cancer patients to determine whether cancer has metastasized to the lymph nodes under the arm (axillary lymph nodes). This procedure relies on the identification and mapping of those lymph nodes most likely to contain cancer cells (sentinel nodes). The methods commonly used in sentinel node mapping- staining with blue dye or imaging techniques-have been shown to be less effective in overweight patients, possibly due to an alteration in the structure of nodal tissue and technological limits on the imaging method used, called planar imaging.
In a recent study, 220 women with invasive breast cancer were studied using both planar imaging and more advanced SPECT/CT imaging which has improved image quality and spatial resolution. In SPECT imaging a small amount of radioactive material is injected into the patient. The imaging results show the distribution of the material. It can be used to locate cancer cells and track blood flow.
Comparison of the two different image-based detection techniques revealed that planar imaging detected sentinel nodes in 78% of patients and SPECT/CT imaging detected 91%. For the 122 overweight and obese patients (body mass index >25) planar imaging was successful in 72% and SPECT/CT detected sentinel nodes in 89% of patients. From these results it appears that traditional planar imaging is less useful in patients with increasing body mass index (72% for overweight subjects compared to 78% overall). SPECT/CT detection capabilities remain more constant (89% for overweight subjects compared to 91% overall). This indicates that this new technique may be especially beneficial for overweight and obese patients. SPECT/CT also detected sentinel nodes in 36 patients for whom the intraoperative blue dye test was negative, showing the possible superiority of this new imaging technique. The results of this study are especially important since the risk of lymphedema as a complication of axillary lymph node removal is higher in overweight patients. Importantly, six of the nineteen patients with negative results on all sentinel node detection techniques were found to have metastatic involvement of sentinel nodes when axillary lymph node removal was performed; it is evident that SPECT/CT imaging is not a flawless test for breast cancer metastasis to the lymph nodes.
In a recent study, 220 women with invasive breast cancer were studied using both planar imaging and more advanced SPECT/CT imaging which has improved image quality and spatial resolution. In SPECT imaging a small amount of radioactive material is injected into the patient. The imaging results show the distribution of the material. It can be used to locate cancer cells and track blood flow.
Comparison of the two different image-based detection techniques revealed that planar imaging detected sentinel nodes in 78% of patients and SPECT/CT imaging detected 91%. For the 122 overweight and obese patients (body mass index >25) planar imaging was successful in 72% and SPECT/CT detected sentinel nodes in 89% of patients. From these results it appears that traditional planar imaging is less useful in patients with increasing body mass index (72% for overweight subjects compared to 78% overall). SPECT/CT detection capabilities remain more constant (89% for overweight subjects compared to 91% overall). This indicates that this new technique may be especially beneficial for overweight and obese patients. SPECT/CT also detected sentinel nodes in 36 patients for whom the intraoperative blue dye test was negative, showing the possible superiority of this new imaging technique. The results of this study are especially important since the risk of lymphedema as a complication of axillary lymph node removal is higher in overweight patients. Importantly, six of the nineteen patients with negative results on all sentinel node detection techniques were found to have metastatic involvement of sentinel nodes when axillary lymph node removal was performed; it is evident that SPECT/CT imaging is not a flawless test for breast cancer metastasis to the lymph nodes.
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