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      Feasibility of preoperative 125I seed-guided tumoural tracer injection using freehand SPECT for sentinel lymph node mapping in non-palpable breast cancer


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          This study was designed to explore the feasibility of replacing the conventional peri-/intratumoural ultrasound (US)-guided technetium-99m albumin nanocolloid ( 99mTc-nanocolloid) administration by an injection of the same tracer guided by a freehand single-photon emission computed tomography (SPECT) device in patients with non-palpable breast cancer with an iodine-125 ( 125I) seed as tumour marker, who are scheduled for a sentinel lymph node biopsy (SLNB). This approach aimed to decrease the workload of the radiology department, avoiding a second US-guided procedure.


          In ten patients, the implanted 125I seed was primarily localised using freehand SPECT and subsequently verified by conventional US in order to inject the 99mTc-nanocolloid. The following 34 patients were injected using only freehand SPECT localisation. In these patients, additional SPECT/CT was acquired to measure the distance between the 99mTc-nanocolloid injection depot and the 125I seed. In retrospect, a group of 21 patients with US-guided 99mTc-nanocolloid administrations was included as a control group.


          The depth difference measured by US and freehand SPECT in ten patients was 1.6 ± 1.6 mm. In the following 36 125I seeds (34 patients), the average difference between the 125I seed and the centre of the 99mTc-nanocolloid injection depot was 10.9 ± 6.8 mm. In the retrospective study, the average distance between the 125I seed and the centre of the 99mTc-nanocolloid injection depot as measured in SPECT/CT was 9.7 ± 6.5 mm and was not significantly different compared to the freehand SPECT-guided group (two-sample Student's t test, p = 0.52).


          We conclude that using freehand SPECT for 99mTc-nanocolloid administration in patients with non-palpable breast cancer with previously implanted 125I seed is feasible. This technique may improve daily clinical logistics, reducing the workload of the radiology department.

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          Comparing methods of measurement: why plotting difference against standard method is misleading.

          When comparing a new method of measurement with a standard method, one of the things we want to know is whether the difference between the measurements by the two methods is related to the magnitude of the measurement. A plot of the difference against the standard measurement is sometimes suggested, but this will always appear to show a relation between difference and magnitude when there is none. A plot of the difference against the average of the standard and new measurements is unlikely to mislead in this way. We show this theoretically and by a practical example.
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            Lymphatic drainage patterns from the breast.

            The aim of this study was to describe the lymphatic drainage patterns from the 5 "quadrants" of the breast. Lymphatic mapping has provided techniques to visualize and harvest sentinel nodes in various locations and has generated renewed interest in nodes outside the axilla. Between January 1997 and June 2002, 700 sentinel node procedures were performed in patients with cN0 breast cancer. Preoperative lymphoscintigraphy was performed after injection of 99mTc-nanocolloid into the tumor in a volume of 0.2 mL and a mean dose of 107.7 MBq (2.8 mCi). Intraoperatively, the sentinel node was pursued with the aid of a gamma-ray detection probe and patent blue dye (1.0 mL, into the lesion). The patients were divided into 5 groups according to the location of the primary breast cancer. In each group, a distinction was made between palpable and nonpalpable lesions of the breast. Drainage to either an axillary or an extra-axillary basin was observed in 678 patients. Both palpable and nonpalpable lesions may drain toward the internal mammary chain, although the latter more frequently, regardless of the quadrant. Drainage was also observed to supraclavicular, infraclavicular, interpectoral, and intramammary sentinel nodes. In each quadrant, a breast cancer may drain to sentinel nodes in various locations. There is a distinct difference in drainage patterns between palpable and nonpalpable lesions. These findings may improve the assessment of lymphatic dissemination in invasive breast cancer.
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              Current status of radioactive seed for localization of non palpable breast lesions.

              Wire-localized breast biopsy (WLBB) remains the standard method for the surgical excision of nonpalpable breast lesions. Because of many of its shortcomings, most important a high microscopic positive margin rate, alternative approaches have been described, including radioactive seed localization (RSL). This review highlights the literature regarding RSL, including safety, the ease of the procedure, billing, and oncologic outcomes. Medline and PubMed were searched using the terms "radioactive seed" and "breast." All peer-reviewed studies were included in this review. RSL is a promising approach for the resection of nonpalpable breast lesions. It is a reliable and safe alternative to WLBB. RSL is at least equivalent compared with WLBB in terms of the ease of the procedure, removing the target lesion, the volume of breast tissue excised, obtaining negative margins, avoiding a second operative intervention, and allowing for simultaneous axillary staging. Copyright 2010 Elsevier Inc. All rights reserved.

                Author and article information

                EJNMMI Res
                EJNMMI Res
                EJNMMI Research
                3 May 2014
                : 4
                : 19
                [1 ]MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede 7500 AE, The Netherlands
                [2 ]Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
                [3 ]Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX, The Netherlands
                Copyright © 2014 Pouw et al.; licensee Springer

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                : 22 January 2014
                : 27 March 2014
                Original Research

                Radiology & Imaging
                freehand spect,declipse®spect,125iodine seed,sentinel lymph node biopsy,non-palpable breast cancer


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