Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia.
University of Sydney, Westmead Clinical school, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Jun;92(6):1434-1439. doi: 10.1111/ans.17659. Epub 2022 Mar 31.
The aim of this study is to determine the prevalence of incidental radiological findings detected on SPECT/CT performed as part of pre-operative lymphoscintigraphy for sentinel lymph node biopsy (SLNB) in patients undergoing breast cancer surgery and development of a modified classification to workup these lesions.
A retrospective audit was performed of all SPECT/CT performed in combination with lymphoscintigrams in breast cancer patients presenting with clinically node negative axillae and operated on by breast surgeons at the Westmead Breast Cancer Institute over a 12-month period.
Four hundred and nineteen patients were included in the study. In 149 patients (35.6%), there was a total of 205 incidental findings. The most common findings were, pulmonary abnormalities (38.5%), abdominal findings (27.8%), thyroid nodules (14.6%), cardiac abnormalities (10.7%) and others (8.3%). Using our proposed Westmead SPECT/CT incidental findings (WSIF) classification, 7.8% were known, 17.6% were major findings, 48.3% were minor findings, 15.1% were minimal findings and 11.2% were equivocal findings. 17.6% (n = 36) underwent further workup and investigation and 3.4% of patients (n = 5) required therapeutic intervention, including chemotherapy for primary lung cancer(n = 1) and surgeries (thoracotomy, n = 1; thyroidectomy, n = 2; colonoscopy, n = 1). 93.8% (n = 393) had at least one SLN mapped, most commonly located in Level 1 of the axilla.
The incidental findings on SPECT/CT in combination with lymphoscintigraphy is within the range of previous studies (27.3-59.5%). A small proportion of patients required significant major interventions (3.4%). We propose that all incidental findings should be assessed according to our WSIF classification to aid in triaging need for further investigation and management.
本研究旨在确定在接受乳腺癌手术的患者中，作为前哨淋巴结活检（SLNB）术前淋巴闪烁显像一部分进行的 SPECT/CT 检测到的偶然放射学发现的发生率，并制定一种改良的分类方法来检查这些病变。
对在过去 12 个月内在 Westmead 乳腺癌研究所由乳腺外科医生为临床腋窝淋巴结阴性的乳腺癌患者进行的所有 SPECT/CT 与淋巴闪烁显像相结合的病例进行回顾性审核。
本研究共纳入 419 例患者。在 149 例患者（35.6%）中，共有 205 例偶然发现。最常见的发现是肺部异常（38.5%）、腹部发现（27.8%）、甲状腺结节（14.6%）、心脏异常（10.7%）和其他（8.3%）。使用我们提出的 Westmead SPECT/CT 偶然发现（WSIF）分类，已知的有 7.8%，主要发现的有 17.6%，次要发现的有 48.3%，最小发现的有 15.1%，不确定发现的有 11.2%。17.6%（n=36）接受了进一步的检查和调查，3.4%的患者（n=5）需要治疗干预，包括原发性肺癌的化疗（n=1）和手术（开胸术，n=1；甲状腺切除术，n=2；结肠镜检查，n=1）。93.8%（n=393）至少有一个 SLN 被定位，最常见的位于腋窝的 1 级。
SPECT/CT 结合淋巴闪烁显像的偶然发现与之前的研究（27.3-59.5%）相符。少数患者需要进行重大干预（3.4%）。我们建议所有偶然发现都应根据我们的 WSIF 分类进行评估，以帮助确定进一步检查和管理的需求。
