68Ga-NEB PET/CT can be a new method for diagnosing chylous fistula Case reports of a rare complication after breast cancer surgery

Rationale: We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided.Ga-68-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. Patient concerns: A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. Diagnoses: The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method,Ga-68-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. Interventions: We successfully obtained clear images to locate the fistula using(68)Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the(68)Ga-NEB activity during PET/CT. Outcomes: Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. Lessons: Ga-68-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.