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Lymphatic Mapping in Patients with Breast Carcinoma: Reproducibility of Lymphoscintigraphic Results¹

¹ From the Departments of Surgery (P.J.T., O.E.N.) and Nuclear Medicine (R.A.V.O., S.H.M.), Netherlands Cancer Institute, Amsterdam. Received May 28, 2002; revision requested July 18; final revision received November 18; accepted December 10. Address correspondence to P.J.T., Department of Surgery, St Lucas Andreas Hospital, Jan Tooropstraat 164, 1006 AE Amsterdam, the Netherlands (e-mail: p.tanis@slaz.nl).

PURPOSE: To evaluate the reproducibility of lymphoscintigraphic results in assessment of the location and number of sentinel nodes in patients with breast cancer.

MATERIALS AND METHODS: Twenty-five patients with breast cancer were prospectively enrolled in this study. Lymphoscintigraphy was performed after intratumoral injection of about 130 MBq of technetium 99m nanocolloid. Anterior and lateral images were obtained 20 minutes and 2 and 4 hours after injection. The following day, scintigraphy was repeated after a second injection of the radiolabeled colloid in an identical fashion and was preceded by acquisition of a starting image. Two observers evaluated the paired images independently, and count rates were calculated from the images. Correlation coefficient and Bland-Altman methods were used to analyze the paired count rates.

RESULTS: At least one sentinel node was visualized at lymphoscintigraphy in all 25 patients. Drainage to the axilla was observed in 17 patients; drainage to the axilla and extraaxillary basins, in seven patients; and drainage exclusively to extraaxillary sentinel nodes, in one patient. The second scintigraphic study revealed the same drainage pattern in all 25 patients (reproducibility, 100%; 95% CI: 86%, 100%). The Pearson correlation coefficient of the paired count rates was 0.54 (P < .001). Count rates at repeat scintigraphy were 23%–417% of the count rates at first scintigraphy in 95% of cases.

CONCLUSION: Results of lymphoscintigraphy for lymphatic mapping in breast cancer are highly reproducible for assessment of the number of sentinel nodes.

© RSNA, 2003

Index terms: Breast neoplasms, radionuclide studies, 08.12166 • Lymphatic system, radionuclide studies, 997.12974 • Radionuclide imaging, in diagnosis of neoplasms

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