ORIGINAL ARTICLES   

The Quarterly Journal of Nuclear Medicine 2003 June;47(2):116-28

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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

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.