Diagnostic and prognostic value of additional SPECT/CT in sentinel lymph node mapping in breast cancer patients

Summary

The aim of the study was to demonstrate the diagnostic and prognostic value of SPECT/CT in sentinel lymph node mapping (SLNM) in patients with invasive breast cancer. Methods: 114 patients with invasive breast cancer with clinically negative lymph nodes were included in this retrospective study as they were referred for SLNM with ^99mTc-nanocolloid. Planar image acquisition was accomplished in a one-day or two-day protocol depending on the schedule of the surgical procedure. Low dose SPECT/CT was performed after the planar images. The sentinel lymph node biopsy (SLNB) was considered false negative if a primary recurrence developed within 12 months after SLNB in the axilla from which a tumor-free SLN had been removed. Results: Between December 2009 and December 2011, 114 patients (pts.) underwent SLNM with additional SPECT/CT. Planar imaging identified in 109 pts. 139 SLNs, which were tumor-positive in 42 nodes (n = 41 pts.). SPECT/CT identified in 81 pts. 151 additional SLNs, of which 19 were tumor-positive and led to therapy change (axillary lymph node dissection) in 11 pts. (9.6 %). Of overall 61 tumor-positive SLNs (n = 52 pts.) SPECT/CT detected all, whereas planar imaging detected only 42 of 61 (P < 0.0001). No patient had lymph node metastasis within 12 months after SLNB in the axilla from which a tumor-free SLN had been removed resulting in a false-negative rate of 0 %. The local relapse rate was 1.8 % leading to a 4-year disease-free survival rate of 90 %. Conclusion: Among patients with breast cancer, the use of SPECT/CT-aided SLNM correlated due to a better anatomical localization and identification of planar not visible SLNs with a higher detection rate of SLNs. This led to therapeutic consequences and an excellent false-negative and 4-year disease-free survival rate.

Zusammenfassung

Ziel: Ziel dieser Studie war es, den diagnostischen und prognostischen Wert des SPECT/CT bei der Detektion von Wächterlymphknoten (SLN) bei Mammakarzinompatientinnen zu analysieren. Methodik: 114 Patientinnen mit invasivem Mammakarzinom, klinisch negativem Lymphknotenstatus und Wächterlymphknotenszintigraphie (SLNM) mit ^99mTc-Nanokolloid wurden eingeschlossen. Die planare Bildaquisition erfolgte je nach Operationsplanung entweder in einem 1- oder 2-Tages-Protokoll. Die SPECT/CT (low dose)-Aufnahmen folgten im Anschluss an die planaren Aufnahmen. Die Wächterlymphknotenbiopsie (SLNB) wurde als falsch negativ angesehen, wenn sich ein primäres Rezidiv innerhalb von 12 Monaten nach SLNB in der Axilla entwickelte, von wo ein tumorfreier SLN entfernt wurde. Ergebnisse: Zwischen Dezember 2009 und Dezember 2011 wurde bei 114 Patientinnen (Pat.) ein SLNM mit ergänzendem SPECT/CT durchgeführt. Die planare Szintigraphie detektierte bei 109 Pat. 139 SLNs, von welchen 42 tumorpositiv waren (n = 41 Pat.). SPECT/CT detektierte bei 81 Pat. 151 zusätzliche SLNs, von welchen 19 tumorpositiv waren und bei 11 Pat. (9.6 %) zu einer Therapieänderung (axilläre Lymphknotendissektion) führten. Von insgesamt 61 tumorpositiven SLNs (n = 52 Pat.) detektierte SPECT/CT alle, während die planare Szintigraphie nur 42 von 61 (P < 0.0001) detektierte. Keine Patientin hatte eine Lymphknotenmetastase in der Axilla innerhalb von 12 Monaten nach SLNB, von welcher ein tumorfreier SLN entfernt wurde, was zu einer Falsch-negativen-Rate von 0 % führte. Die Lokalrezidivrate betrug 1.8 %, was zu einer 4-Jahres-krankheitsfreien Überlebensrate von 90 % führte. Schlussfolgerungen: Bei Mammakarzinompatientinnen führte das ergänzende SPECT/CT zu einer deutlich besseren Identifikation und anatomischen Zuordnung des SLN, dies vor allem bei den planar nicht sichtbaren SLNs. Dies führte zur konsekutiven Änderung des Therapieregimes und einer exzellenten Falschnegativen und 4-Jahres-krankheitsfreien Überlebensrate.

Keywords

Breast cancer - sentinel lymph node mapping - SPECT/CT - prognosis

Schlüsselwörter

Mammakarzinom - Wächterlymphknotenszintigraphie - SPECT/CT - Prognose

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