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SPECT-CT localization of axillary sentinel lymph nodes for radiotherapy of early breast cancer - PubMed

SPECT-CT localization of axillary sentinel lymph nodes for radiotherapy of early breast cancer

Sergey Novikov et al. Rep Pract Oncol Radiother. 2019 Nov-Dec.

Abstract

Purpose: To evaluate the opportunities of single photon emission tomography/computerized tomography (SPECT-CT) for localization of axillary sentinel lymph nodes (ASLNs) and subsequent radiotherapy planning in women with early breast cancer.

Material and methods: Individual topography of ASLN was determined in 151 women with clinical T1-2N0M0 breast cancer. SPECT-CT visualization of ASLNs was initiated 120 min after intra-peritumoral injection of 99mTc-radiocolloids. Doses absorbed by virtual ASLNs after the whole breast irradiation with standard and extended tangential fields were calculated on a treatment planning station.

Results: SPECT-CT demonstrated a large variability of ASLN localization. They were detected in the central subgroup in 94 (61%) patients, in pectoral - in 77 (51%), and in interpectoral - in 4 (3%) patients. Sentinel lymph nodes "lying on the chest" were revealed in 35 (23%) cases.We found that with standard tangential fields coverage of ASLNs was obtained only in 20% of evaluated women. Extended tangential fields can effectively irradiate ASLNs localized in all axillary sub-regions with the exception of ASLNs "lying on the chest".

Conclusion: SPECT-CT mapping of ASLNs in women with cT1-2N0M0 breast cancer reveals their variable localization. This information can be important for planning of radiation treatment in women that underwent breast conserving surgery without an axillary surgery.

Keywords: Breast cancer; Imaging; Radiotherapy; Sentinel lymph nodes.

© 2019 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.

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Figures

Fig. 1
Fig. 1

SPECT-CT axial views obtained after intratumoral injection of 99mTc-radiocolloids. (a) Sentinel lymph node located in the apical subgroup of axillary lymph nodes (big yellow arrow). (b) Sentinel lymph node that corresponds to Sorgius lymph node (red arrow).

Fig. 2
Fig. 2

Fused SPECT-CT axial images of pectoral sentinel lymph nodes. (a) Sentinel lymph node located between the pectoral muscles. (b) Subpectoral sentinel lymph node.

Fig. 3
Fig. 3

Sentinel lymph node visualized in subscapular region (injection site marked by a white arrow).

Fig. 4
Fig. 4

SPECT-CT images of the apical sentinel lymph nodes (axial, sagittal and coronal views).

Fig. 5
Fig. 5

Fused SPECT-CT images in transverse and sagittal views, showing pectoral sentinel lymph node located “on the thoracic wall” (arrow).

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