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The Quarterly Journal of Nuclear Medicine 1998 March;42(1):54-65


lingua: Inglese

Nuclear medicine approaches for detection of axillary lymph node metastases

Bombardieri E., Crippa F., Maffioli L., Draisma A.**, Chiti A., Agresti R.*, Greco M.*

From the Division of Nuclear Medicine *Division Surgical Oncology B Istituto Nazionale Tumori, Milan, Italy **Department Radiology Leiden University Medical Center, Leiden, The Netherland


In ­breast can­cer ­patients the detec­tion of axil­lary ­lymph ­node involve­ment is a ­very crit­i­cal ­issue, in ­view of the ear­li­er diag­no­sis of the dis­ease in ­recent ­years, and the ­increased fre­quen­cy of ­very ­small ­tumors at ­first pres­en­ta­tion. The ­size of can­cer is relat­ed to the ­risk of axil­lary metas­ta­ses, and ­this may ­affect the prog­no­sis and the ther­a­peu­tic strat­e­gies. Axillary ­lymph ­node involve­ment is gen­er­al­ly rec­og­nized as an ­index of dis­tant micro­dif­fu­sion, and as it ­affects over­all and dis­ease-­free sur­vi­val, rep­re­sents the ­basis for adop­tion of adju­vant chem­o­ther­a­py. Routine axil­lary ­lymph ­node dis­sec­tion (­ALND) is expen­sive, and ­does not ben­e­fit ­about 70% of ear­ly ­breast can­cer ­patients ­which are ­node neg­a­tive (pN-). Today most of ­these ­patients ­have to sus­tain the poten­tial mor­bid­ity and the eco­nom­ic ­costs of ­ALND. The clin­i­cal ­approach is ­known to be an unre­al­i­able diag­nos­tic ­tool, and for the detec­tion of axil­lary metas­ta­ses, con­ven­tion­al X-ray tech­niques are ­also ­unable to ­solve the prob­lem. By con­trast, nucle­ar med­i­cine pro­ce­dures ­have ­revealed a ­very inter­est­ing diag­nos­tic poten­tial in ­recent ­years. This ­paper ana­lyz­es the numer­ous stud­ies con­duct­ed in the ­field of ­lymph ­node vis­u­al­iza­tion and the het­ero­ge­ne­ity of the pub­lished expe­ri­enc­es, tak­ing ­into ­account the dif­fer­ent approach­es pro­posed in the lit­er­a­ture: a) imag­ing ­with gam­ma-emit­ting ­tumor seek­ing ­agents; b) radio­im­mu­nos­cin­tig­ra­phy ­intra-­venous (i.v.) or by the inter­sti­tial ­route; c) lym­phos­cin­tig­ra­phy ­with col­loids and gam­ma ­probe sen­ti­nel biop­sy; d) posi­tron emis­sion tomog­ra­phy (PET). Although it is ­very dif­fi­cult to ­make a defin­i­tive state­ment ­about the clin­i­cal effi­ca­cy of all ­these meth­ods, ­this ­paper ­reports the ­most impor­tant ­series of ­patients exam­ined in the li-t­er­a­ture as ­well as the ­author’s own expe­ri­enc­es. This can ­serve as the ­basis for a bet­ter under­stand­ing of the poten­tial of nucle­ar med­i­cine pro­ce­dures, and ­gives the read­er the oppor­tu­nity to ­weigh advan­tag­es and draw­backs of ­each meth­od. At ­present, lym­phos­cin­tig­ra­phy ­with gam­ma ­probe sen­ti­nel biop­sy and FDG-PET ­are the nucle­ar med­i­cine approach­es ­with the ­best diag­nos­tic per­for­mance. However, a cor­rect com­par­i­son of the meth­ods ­will not be pos­sible, ­until ­their care­ful assess­ment in the ­same ­patients is performed. In addi­tion, a ­final state­ment ­today ­should con­sid­er ­also the increas­ing ­need to car­ry out an eco­nom­ic anal­y­sis by eval­u­at­ing the ­cost-effec­tive­ness of the exam­ina­tions.

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