• The Korean Journal of Nuclear Medicine
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• v.33 no.3
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• pp.243-246
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• 1999

Currently, dissection of the axillary or regional lymph nodes is considered the standard staging procedure in breast cancer. However, accumulating evidence is becoming available that the sentinel node concept may provide the same or even better staging information. In the case of melanoma, it is proven that the histological characteristics of the sentinel node reflect the histological characteristics of the distal part of the lymphatic basin. Morbidity can be reduced significantly by the use of sentinel node dissection as several authors have reported successful introduction of this technique into clinical practice. But in breast cancer patients, there are signigicant differences in practice relating to the technology, such as radiopharmaceuticals, injection sites, volume of injectate, combination with vital blue dye, preoperative lymphoscintigraphy, etc. Valuable reports on these topics appeared in recent journals. This review is a summary of those reports for nuclear physicians interested in sentinel node detection by lymphoscintigraphy in breast cancer patients.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.6
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• pp.451-455
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• 2008

Purpose: Lymphoscintigraphy and sentinel node biopsy has become a standard method for detection of axillary lymph node metastasis in breast cancer patients, but the standard radiopharmaceutical was not prepared. About detection of axillary lymph node metastasis by lymphoscintigraphy and sentinel node biopsy in breast cancer patient, we compared the results of Tc-99m Tin-colloid and Tc-99m Phytate by subareolar injection. Materials and Methods: This study included 382 breast cancer patients who were performed operation during 2001-2008. Three hundred forty nine patients was injected 0.8ml of Tc-99m Tin-colloid (37-185 MBq) by subareolar injection. Thirty three patients was injected 0.8ml of Tc-99m Phytate (37-185 MBq). Lymphoscintigraphy was performed in supine position and sentinel node localization was performed by hand-held gamma probe in operation. Result: Among 349 patients by Tc-99m Tin-colloid, 312 cases (89.4%) localized the sentinel node by lymphoscintigraphy, 304 cases (87.1%) localized by gamma probe. Among 33 patients by Tc-99m Phytate, 32 cases (97.0%) localized by lymphoscintigraphy, 33 cases (100%) localized by gamma probe. Detection rate by lymphoscintigraphy and gamma probe was superior for Tc-99m Phytate compared to that with Tc-99m Tin-colloid, with a statistically significant difference. (p<0.05, p<0.05) Conclusion: Tc-99m Phytate is a better choice for localization of sentinel node than Tc-99m Tin-colloid in breast cancer patients.

• Journal of Biomedical Engineering Research
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• v.31 no.2
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• pp.114-122
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• 2010

This paper presents a method that registers a lymphoscintigraphy to the real image captured by a CMOS camera, which helps surgeons to easily and precisely detect sentinel lymph nodes for sentinel lymph node biopsy in breast cancer patients. The proposed method consists of two steps: pre-matching and image registration. In the first step, we localize fiducial markers in a lymphoscintigraphy and a real image of a four quadrant bar phantom by using image processing techniques, and then determines perspective transformation parameters by matching with the corresponding marker points. In the second step, we register a lymphoscintigraphy to a real images of patients by using the perspective transformation of pre-matching. To examine the accuracy of the proposed method, we conducted an experiment with a chest mock-up with radioactive markers. As a result, the euclidean distance between corresponding markers was less than 3mm. In conclusion, the present method can be used to accurately align lymphoscintigraphy and real images of patients without attached markers to patients, and then provide useful anatomical information on sentinel lymph node biopsy.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.1
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• pp.55-59
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• 2009

Purpose: Lymphoscintigraphy and sentinel node biopsy are used in detection of axillary lymph node metastasis in breast cancer patients, but standardized technique is not established. We compared the results of the injection the morning of surgery (1 day protocol) with the subareolar injection the day before surgery (2 day protocol) with the subareolar injection in patients with breast cancer having lymphoscintigraphy and sentinel node biopsy. Materials and Methods: This study included 349 patients who underwent the breast cancer operation during 2001-2004. One hundred seventy one patients (1 day protocol, 1 hour) was injected 0.8ml of Tc-99m Tin-Colloid (37 MBq) by subareolar injection on the morning of surgery. One hundred seventy eight patients (2 day protocol, 16 hour) was injected 0.8 ml of T c-99m Tin-Colloid (185 MBq) on the afternoon before surgery. Lymphoscintigraphy was performed in sitting position and sentinel node localization was performed by hand-held gamma probe during operation. Result: In the 1 day protocol, 153 cases (89.5%) of the sentinel node were localized by lymphoscintigraphy and 150 cases (87.7%) were localized by gamma probe. In the 2 day protocol, 159 cases (89.3%) were localized by lymphoscintigraphy and 154 cases (86.5%) were localized by gamma probe. There was no significant difference in localization of sentinel node between the 1 day and the 2 day protocol by lymphoscintigraphy and gamma probe (p>0.05, p>0.05). Conclusion: There was no difference the result of localization of sentinel node with subareolar injection between the 1 day and the 2 day protocol in breast cancer patients. Because the 2 day protocol allows the enough time of performing lymphoscintigraphy, it is more useful in localization of sentinel node in breast cancer patients.

• The Korean Journal of Nuclear Medicine
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• v.34 no.6
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• pp.478-486
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• 2000

Purpose: The sentinel lymph node is defined as the first draining node from a primary tumor and reflects the histologic feature of the remainder of the lymphatic basin status. The aim of this study was to evaluate the usefulness of lymphoscintigraphy and intraoperative radioguided gamma probe for identification and removal of sentinel lymph node in breast cancer. Materials and Methods: Lymphoscintigraphy was performed preoperatively in 15 patients with biopsy proven primary breast cancer. Tc-99m antimony sulfide colloid was injected intradermally at four points around the tumor. Imaging acquisition included dynamic imaging, followed by early and late static images at 2 hours. The sentinel lymph node criteria on lymphoscintigraphy is the first node of the highest uptake in early and late static images. We tagged the node emitting the highest activity both in vivo and ex vivo. Histologic study for sentinel and axillary lymph node investigation was done by Hematoxylin-Eosin staining. Results: On lymphoscintigraphy, three of 15 patients had clear lymphatic vessels in dynamic images, and 11 of 15 patients showed sentinel lymph node in early static image and three in late static 2 hours image. Mean detection time of sentinel lymph node on lymphoscintigraphy was $33.5{\pm}48.4$ minutes. The sentinel lymph node localization and removal by lymphoscintigraphy and intraoperative gamma probe were successful in 14 of 15 patients (detection rate: 93.3%). On lymphoscintigraphy, 14 of 15 patients showed $2.47{\pm}2.00$ sentinel lymph nodes. On intraoperative gamma probe, $2.36{\pm}1.96$ sentinel lymph nodes were detected. In 7 patients with positive results of sentinel lymph node metastasis, 5 patients showed positive results of axillary lymph node (sensitivity: 72%) but two did not. In 7 patients with negative results of sentinel lymph node metastasis, all axillary nodes were free of disease (specificity: 100%). Conclusion: Sentinel lymph node biopsy with lymphoscintigraphy and intraoperative gamma probe is a reliable method to predict axillary lymph node metastasis in breast cancer, and unnecessary axillary lymph node dissection can be avoided.

• Archives of Plastic Surgery
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• v.32 no.5
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• pp.635-640
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• 2005

Sentinel lymphnode biopsy is widely performed in the management of malignant melanoma and breast cancer. The sentinel lymphnode is the prime site of draining from the malignant lesion and of metastasis. The aim of this study was to evaluate a usefulness of lymphoscintigraphy in conjunction with a removal of sentinel lymphnodes of skin and soft tissue malignancy. We studied 11 patients selected between January, 2003 and November, 2004. Clinically sentinel lymphnodes free of metastasis were examined with lymphoscintigraphy, gamma detection probe and vital dye staining, and we reviewed histopathologic findings and inert status of the nodes and the results fo treatment. Nine cases were malignant melanoma, one was squamous cell carcinoma on the left hand and another one leiomyosarcoma. Sentinel lymphnodes were identified in all cases. Three cases of malignant melanoma had positive sentinel lymphnodes on histological examination. All patients with positive sentinel lymphnodes were treated with therapeutic regional lymphadectomy, chemotherapy and adjuvant regimen. Four patients underwent PET scanning and followed sentinel lymphnode biopsy. Two had no metastasis signs on PET scanning. Therapeutic lymphnode dissection was carried out upon the patients whose sentinel lymphnode was positive on PET scanning. We contend that lymphoscintigraphy and sentinel lymphnode biopsy are reliable to confirm regional lymphnode metastasis of the skin and soft tissue malignancy, and blind extensive lymphnode dissection can be spared.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.25-29
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• 2009

Purpose: Several radioactive agents were used for lymphoscintigraphy in breast cancer. But recently, due to the change of local radiopharmaceutical licensing policy and discontinuation of supplies from manufacturer, we could not use many radiocolloids such as $^{99m}Tc$-Antimony Trisulfide Colloid, $^{99m}Tc$-Tin Colloid, $^{99m}Tc$-Human Serum Albumin. So it is necessary to use the substitution radiopharmaceutical. Therefore, this study aims to evaluate the performance of substitution radiopharmaceutical ($^{99m}Tc$-Phytate) including the existing radiocolloids and to set up of the appropriate protocol in lymphoscintigraphy. Materials and Methods: For each radiocolloids ($^{99m}Tc$-Antimony Trisulfide Colloid (ASC), $^{99m}Tc$-Tin Colloid (TC), $^{99m}Tc$-Human Serum Albumin (HSA), $^{99m}Tc$-Phytate) were performed the particle size by Zeta Sizer (Nano-ZS) and we compared the radiolabeling time, procedure and acquisition time for each of the radiocolloids (total 200 patients). For the last time, we made an analysis of image for each of the radiocolloids with our previous report (SJ Jang et al, Korean Nucl Med Mol imaging Vol.41, No.6, Dec 2007). Results: The particle size of each radiocolloids showed A.S.C (50 nm), T.C (310 nm), H.S.A (10.8 nm), $^{99m}Tc$-Phytate (499 nm). The labeling and acquisition time for each of the radiocolloids showed no substantial difference. But there is difference of the labeling time for the A.S.C. because the ASC procedure need to boiling process. There were no significant differences among those radiocolloids (p>0.005) in the identification rate (IR), false negative rate (FNR), and negative predictive value (NPV). Conclusions: $^{99m}Tc$-labeled radiocolloids showed equivalent results in lymphoscintigraphy. Therefore, in this exam of each radiocolloids could be applied appropriate protocol in lymphoscintigraphy.

• 대한핵의학회:학술대회논문집
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• 2000.05a
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• pp.67.1-67.1
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• 2000

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.133-137
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• 2010

Purpose: Breast cancer is known to be more vulnerable to bone metastasis and lymph node metastasis than other types of cancer, and nuclear examinations whole body bone scan and lymphoscintigraphy are performed commonly before and after breast cancer operation. In case whole body bone scan is performed on the day before lymphoscintigraphy, the radiopharmaceutical taken into and remaining in the bones provides anatomical information for tracking and locating sentinel lymph nodes. Thus, this study purposed to examine how much bone density affects in locating sentinel lymph nodes. Materials and Methods: The subjects of this study were 22 patients (average age $52{\pm}7.2$) who had whole body bone scan and lymphoscintigraphy over two days in our hospital during the period from January to December, 2009. In the blind test, 22 patients (average age $57{\pm}6.5$) who had lymphoscintigraphy using $^{57}Co$ flood phantom were used as a control group. In quantitative analysis, the relative ratio of the background to sentinel lymph nodes was measured by drawing ROIs on sentinel lymph nodes and the background, and in gross examination, each of a nuclear physician and a radiological technologist with five years' or longer field experience examined images through blind test in a five-point scale. Results: In the results of quantitative analysis, the relative ratio of the background to sentinel lymph nodes was 14.2:1 maximum and 8.5:1 ($SD{\pm}3.48$) on the average on the front, and 14.7:1 maximum and 8.5:1 ($SD{\pm}3.42$) on the average on the side. In the results of gross examination, when $^{57}Co$ flood phantom images were compared with images containing bones, the score was relative high as 3.86 ($SD{\pm}0.35$) point for $^{57}Co$ flood phantom images and 4.09 ($SD{\pm}0.42$) for bone images. Conclusion: When whole body bone scan was performed on the day before lymphoscintigraphy, the ratio of the background to sentinel lymph nodes was over 10:1, so there was no problem in locating lymph nodes. In addition, we expect to reduce examination procedures and improve the quality of images by indicating the location of sentinel lymph nodes using bone images as body contour without the use of a source.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5385-5389
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• 2012

Introduction: Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in nodenegative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry. Material and Medthod: Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery. Results: 78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected. Conclusion: SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.