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CC BY-NC-ND 4.0 · World J Nucl Med 2020; 19(04): 445
DOI: 10.4103/wjnm.WJNM_38_20
Letter to Editor

Techniques for sentinel node detection in breast cancer

Joseph Lee
1   Department of Medical Imaging, The Prince Charles Hospital, Chermside, Queensland, Australia
2   Faculty of Medicine, University of Queensland, Herston
,
Diana Tam
3   Department of General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
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Dear Editors,

The fundamental aim of the study by Siddique et al.[1] is sensible and noble. Nuclear medicine and surgical doctors, alike, can benefit immensely from understanding the relative efficacies of sentinel node mapping using radionuclide single-photon emission computed tomography lymphoscintigraphy (SPECT-CT LS) followed by gamma probe detection and the patent blue dye (PBD) technique. The assumption shall be made that they injected both the radiocolloid and the PBD in the same site. Of course, intuition would suggest that different outcomes are yielded if the injection site(s) were different, but this issue should not be encountered if using the same injection site(s).

Even so, there is a substantial discrepancy between the techniques even assuming the same injection site(s). This was also found with other injection techniques, not just subareolar as in this study: peritumoral[2] and intratumoral (intralesional).[3] So how do the authors recommend we approach this problem? It is a little unclear from the most recent guidelines[4],[5] which we should use and when. If sentinel nodes are negative with radionuclide SPECT-CT LS, do we only then need to use PBD? Is that what [Figure 1] should imply?

In our experience, we have found numerous cases where lymph nodes were radioactive but not blue and vice versa lymph nodes which were blue but not radioactive. We have identified malignancies in both groups. Would dual mapping – using both SPECT-CT LS and PBD methods – be the most ideal approach?


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Conflict of Interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.


  • References

  • 1 Siddique M, Hassan A, Nawaz MK, Bashir H, Chaudhry MZ. Comparison between sentinel lymph node hybrid scintigraphy and blue dye technique in breast cancer patients: An institutional experience. World J Nucl Med 2020;19:21-7.
  • 2 Hill AD, Tran KN, Akhurst T, Yeung H, Yeh SD, Rosen PP, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528-35.
  • 3 Doting MH, Jansen L, Nieweg OE, Piers DA, Tiebosch AT, Koops HS, et al. Lymphatic mapping with intralesional tracer administration in breast carcinoma patients. Cancer 2000;88:2546-52.
  • 4 Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998;227:645-51.
  • 5 Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging 2013;40:1932-47.

Address for correspondence

Dr. Joseph C. Lee
Department of Medical Imaging, The Prince Charles Hospital
Chermside, Queensland 4032
Australia   

Publication History

Received: 28 May 2020

Accepted: 28 May 2020

Article published online:
19 April 2022

© 2020. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Siddique M, Hassan A, Nawaz MK, Bashir H, Chaudhry MZ. Comparison between sentinel lymph node hybrid scintigraphy and blue dye technique in breast cancer patients: An institutional experience. World J Nucl Med 2020;19:21-7.
  • 2 Hill AD, Tran KN, Akhurst T, Yeung H, Yeh SD, Rosen PP, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528-35.
  • 3 Doting MH, Jansen L, Nieweg OE, Piers DA, Tiebosch AT, Koops HS, et al. Lymphatic mapping with intralesional tracer administration in breast carcinoma patients. Cancer 2000;88:2546-52.
  • 4 Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998;227:645-51.
  • 5 Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging 2013;40:1932-47.

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