Yasmin Tahira, Numair Younis Muhammad, Masood Misbah, Majeed Khan Huma, Asgher Zahid, Shahid Abubaker
Nuclear Medicine and PET Imaging, Institute of Nuclear Medicine & Oncology (INMOL) Cancer Hospital, Lahore, PAK.
Clinical Oncology, Institute of Nuclear Medicine & Oncology (INMOL) Cancer Hospital, Lahore, PAK.
Cureus. 2022 Jun 16;14(6):e25983. doi: 10.7759/cureus.25983. eCollection 2022 Jun.
Breast cancer is one of the leading causes of cancer-related deaths in women; it is the most frequently diagnosed cancer in women in the United States with a lifetime risk of dying of about 3.4%. Regional lymph node involvement is quite early in breast carcinoma and axillary lymph node metastasis is an important predictor of recurrence and survival, particularly in invasive ductal histology of breast carcinoma. Localization of sentinel lymph node/nodes followed by frozen section and histopathological evaluation helps to prevent unnecessary axillary nodal dissection and, hence, reduces associated post-surgical morbidity. Sentinel nodes are the first ones to receive lymph-borne metastatic cells and, hence, lymphoscintigraphy followed by biopsy is quite reliable to detect nodal metastasis, particularly at an early stage (I, II) of breast cancer.
Here we will share our experience of introducing procedure, personnel training, and workflow of sentinel lymph node lymphoscintigraphy in breast cancer patients at our cancer institute to help other centers establish programs for this study.
Initially, 10 procedures were performed, all of which were successful in the localization of sentinel nodes and played a substantial part in the surgical planning of breast cancer. Planar lymphoscintigraphy and single-photon emission computerized tomography (SPECT)-CT images of our first patient revealed radiotracer avidity in the lymph node in the ipsilateral axilla, which was later on diagnosed as metastatic resulting in axillary nodal clearance.
In multidisciplinary/closely-placed surgical, pathological, and hybrid imaging facility settings, lymphoscintigraphy provides a quick, accurate, and better way of nodal localization leading to correct surgical decision-making. In addition to planar imaging, SPECT-CT acquisition significantly improves the specificity of the lymphoscintigraphy procedure, which is beneficial for patients to avoid false-positive results, thus saving breast cancer patients from potential adverse effects of surgery.
乳腺癌是女性癌症相关死亡的主要原因之一；它是美国女性中最常被诊断出的癌症，终生死亡风险约为3.4%。乳腺癌区域淋巴结受累相当早，腋窝淋巴结转移是复发和生存的重要预测指标，尤其是在浸润性导管组织学类型的乳腺癌中。前哨淋巴结定位，随后进行冰冻切片和组织病理学评估，有助于避免不必要的腋窝淋巴结清扫，从而降低相关的术后发病率。前哨淋巴结是最先接收淋巴转移细胞的淋巴结，因此，淋巴闪烁显像术随后进行活检对于检测淋巴结转移相当可靠，尤其是在乳腺癌的早期阶段（I期、II期）。
在此，我们将分享我们癌症研究所对乳腺癌患者进行前哨淋巴结淋巴闪烁显像术的操作引入、人员培训和工作流程的经验，以帮助其他中心建立该研究项目。
最初进行了10例手术，所有手术均成功定位了前哨淋巴结，并在乳腺癌手术规划中发挥了重要作用。我们第一例患者的平面淋巴闪烁显像和单光子发射计算机断层扫描（SPECT）-CT图像显示，同侧腋窝淋巴结有放射性示踪剂摄取，后来被诊断为转移性，导致腋窝淋巴结清扫。
在多学科/紧密协作的手术、病理和混合成像设备环境中，淋巴闪烁显像术提供了一种快速、准确且更好的淋巴结定位方法，从而做出正确的手术决策。除了平面成像外，SPECT-CT采集显著提高了淋巴闪烁显像术的特异性，这有利于患者避免假阳性结果，从而使乳腺癌患者免受手术潜在不良反应的影响。
