Interest of hybrid SPECT-CT imaging for sentinel node detection in breast cancer

Introduction. - Single-Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) is an hybrid technique which associates functional and morphological images. The aim of this study was to assess the role of SPECT-CT lymphoscintigraphy in sentinel node identification in patients with breast cancer. Methods. - Twelve months prospective study was undertaken. Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 51 consecutive patients with breast cancer (mean age: 62 +/- 11.3, range: 33-83 years). Planar and SPECT-CT images were interpreted separately and the two imaging techniques were compared with respect to their ability to identify sentinel node. Results. - An add-value of SPECT-CT images was evidenced in 31% of cases: a more accurate anatomic localization in 21% of cases and identification of undeterminate sites of uptake in 10% of cases. Furthermore, SPECT-CT detected intramammary (4% of cases) and retromammary (2% of cases) sentinel nodes missed by planar imaging. SPECT-CT was more sensitive for internal mammary drainage detection (6% of cases). The added value proved higher in obese patients. Finally, functional and anatomical images fusion and three-dimensional overview provided clear and readily usable informations to the surgeon. Conclusion. - Hybrid SPECT-CT imaging improves the preoperative localisation of sentinel nodes in patients with breast cancer, in particular in obese patients. SPECT-CT provides readily usable informations to the surgeon. (C) 2010 Elsevier Masson SAS. All rights reserved.