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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

Rivista di Medicina Nucleare e Imaging Molecolare


A Journal on Nuclear Medicine and Molecular Imaging
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The Quarterly Journal of Nuclear Medicine 2003 Giugno;47(2):116-28

lingua: Inglese

The role of 99mTc-tetrofosmin pinhole-SPECT in breast cancer non palpable axillary lymph node metastases detection

Spanu A. 1, Tanda F. 2, Dettori G. 3, Manca A. 2, Chessa F. 1, Porcu A. 3, Falchi A. 1, Nuvoli S. 1, Madeddu G. 1

1 Depart­ment of ­Nuclear Med­i­cine, Uni­ver­sity of Sas­sari, Sas­sari, ­Italy
2 Depart­ment of His­top­a­thology, Uni­ver­sity of Sas­sari, Sas­sari, ­Italy
3 Depart­ment of Sur­gery, Uni­ver­sity of Sas­sari, Sas­sari, ­Italy


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Aim. We eval­u­ated the use­ful­ness of 99mTc-tet­ro­fosmin axil­lary pin­hole (P)-­SPECT in ­breast ­cancer (BC) non pal­pable axil­lary ­lymph ­node metas­tasis detec­tion com­pared ­with con­ven­tional ­planar and ­SPECT scin­ti­mam­mog­raphy.
­Methods. We ­studied pros­pec­tively 188 con­sec­u­tive ­patients ­with sus­pected pri­mary BC, neg­a­tive at axil­lary clin­ical exam­ina­tion. Ten minutes ­after 740 MBq 99mTc-tet­ro­fosmin injec­tion, ­planar and ­SPECT scin­ti­mam­mog­raphy ­were ­acquired, fol­lowed by axil­lary P-­SPECT ­imaging.
­Results. At his­tology, 12 ­patients had ­benign mam­mary ­lesions and 176 had BC. ­Axillary lymph node dissection (ALND) was per­formed in all BC ­patients, bilat­er­ally in 3 ­cases: 74/179 ­axillae had metas­tases. P-­SPECT ­showed a sig­nif­i­cantly ­higher ­overall sen­si­tivity ­than ­SPECT and ­planar (93.2% vs 85.1% and 36.5%, respec­tively; p<0.05 and p<0.0005, respec­tively) and was ­false neg­a­tive in 5 ­patients ­with 1 met­a­static ­node ­each, micro­met­a­static in 4/5 ­cases; ­SPECT and ­planar ­were ­also ­false neg­a­tive in ­these 5 ­cases and in 6 and in 42 fur­ther ­cases, respec­tively. P-­SPECT ­added impor­tant prog­nostic infor­ma­tion by dis­tin­guishing ­single ­from mul­tiple and ≤3 ­from >3 ­nodes; ­only P-­SPECT ­defined the ­exact ­number of ­nodes in 15/25 ­patients ­with 2-4 ­nodes. P-­SPECT ­showed the ­highest accu­racy and NPV: 92.7% and 95%, respec­tively (­SPECT 90.5% and 90%, respec­tively; ­planar 73.2% and 68.9%, respec­tively).
Con­clu­sion. 99mTc-tet­ro­fosmin axil­lary P-­SPECT ­appears ­highly accu­rate in BC non pal­pable axil­lary ­lymph ­node metas­tasis detec­tion and sig­nif­i­cantly ­more sen­si­tive ­than ­both ­planar and ­SPECT, its few ­false neg­a­tive ­results pre­dom­i­nantly con­cerning micro­met­a­stases; more­over, ­only P-­SPECT ­gave addi­tional impor­tant prog­nostic infor­ma­tion. ­Given its ­very ­high NPV, P-­SPECT ­could ­also be ­used to ­better ­select ­patients who ­might ­avoid ­ALND.

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