Lymphoscintigraphy detecting alterations of upper limb lymphatic flow following early sentinel lymph node biopsy in breast cancer
نویسندگان
چکیده
PURPOSE To evaluate early variations in lymphatic circulation of the arm pre- and post-sentinel lymph node biopsy (SLNB) and conservative breast surgery by lymphoscintigraphy (LS). PATIENTS AND METHODS Between 2005 and 2012, 15 patients underwent LS before and after the SLNB (total=30 studies). The pre-SLNB study was considered the control. Early images within twenty minutes (dynamic and static images) and delayed images within ninety minutes of arms and armpits were acquired using a gamma camera. The LS images before and after the SLNB of each patient were paired and compared to each other, evaluating the site of lymphatic flow (in the early phase) and identifying the number of lymph nodes (in the late phase). These dynamic images were subjected to additional quantitative analysis to assess the lymphatic flow rate using the slope assessed by the angular coefficient of the radioactivity × time curves in areas of interest recorded in the axillary region. The variations of lymphatic flow and the number of lymph nodes in the post-SLNB LS compared to the pre-SLNB LS of each patient were classified as decreased, sustained or increased. The clinical variables analyzed included the period between performing the SLNB and the subsequent LS imaging, age, body mass index, number of removed lymph nodes, type of surgery and whether immediate oncoplastic surgery was performed. RESULTS The mean age was 54.53±9.03 years (36-73 years), the mean BMI was 27.16±4.16 kg/m2 (19.3-34.42), and the mean number of lymph nodes removed from each patient was 1.6±0.74 (1-3). There was significant difference in the time between surgery and the realization of LS (p=0.002; Mann-Whitney U test), but in an inverse relationship, the higher was the range, the smaller was the lymphatic flow, indicating a gradual reduction of lymphatic flow after surgery (Spearman's p=0.498, with p=0.013). CONCLUSION Upper limb lymphatic flow gradually decreased after the SLNB and conservative breast surgery in this study, but these results are exploratory because of the small sample size. Further studies are needed to confirm and to investigate more in depth these findings.
منابع مشابه
Feasibility of sentinel lymph node mapping in renal cell carcinoma using intraoperative radiotracer injection
Introduction: The applicability of sentinel lymph node biopsy for early detection of metastasis in patients with renal cell carcinoma (RCC) is still in the validation phase and under investigation, which might be due to the unpredictability of the lymphatic pattern in RCC. In this study, we aimed to evaluate the feasibility and accuracy of sentinel node biopsy in patients with ...
متن کاملTime frame of sentinel node visualization in early breast cancer patients using intradermal injection of Tc-99m phytate: Imaging beyond 45 minutes does not yield more information
Introduction: One of the major problems of lymphoscintigraphy is the time of patient presence in the nuclear medicine wards. The operating room schedule can be compromised if the patients stay longer than usual in the nuclear medicine departments. However, too early imaging can be falsely negative for sentinel node visualization and delayed imaging may be required. The aim of t...
متن کاملThe need for skin pen marking for sentinel lymph node biopsy: A comparative study
Introduction: There is a consensus in the literature that sentinel lymph node biopsy is the standard procedure for axillary staging in early stage (I and II) breast cancer patients. Usually during lymphoscintigraphy, the location of the sentinel lymph node is marked on the skin by an indelible ink. In this study we evaluated this issue in our patients. Methods: 40 ...
متن کاملThe role of ultrasound and lymphoscintigraphy in the assessment of axillary lymph nodes in patients with breast cancer
Breast cancer is the most common malignancy and the leading cause of death due to cancer in European women. Mammography screening programs aimed to increase the detection of early cancer stages were implemented in numerous European countries. Recent data show a decrease in mortality due to breast cancer in many countries, particularly among young women. At the same time, the number of sentinel ...
متن کاملSentinel lymph node in cervical cancer
Background: Cervical cancer is the second most common type of cancer among women. Effective screening programs can help cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has been widely ...
متن کامل