The Hybrid SPECT/CT as an Additional Lymphatic Mapping Tool in Patients with Breast Cancer

BACKGROUND: Conventional lymphoscintigraphy does not always define the exact anatomic location of a sentinel node. The lymphatic drainage pattern may be unusual or may not be shown at all. The recently introduced hybrid SPECT/CT imaging could help overcome these difficulties. SPECT is a tomographic version of conventional lymphoscintigraphy and the images have better contrast and resolution. When fused with the anatomical details provided by CT into one image, a meaningful surgical “roadmap” can be created. So far, there is little literature on the use of hybrid SPECT/CT in lymphatic mapping in patients with breast cancer. The purpose of this review was to report on these publications, including our own experience, focusing on patient selection, SPECT/CT settings, anatomic localization, and the detection of additional sentinel nodes. METHODS: The majority of investigators did not formulate indications for additional SPECT/CT after conventional imaging but scanned all patients eligible for sentinel node biopsy. The SPECT/CT settings used in the studies of this review were mostly similar, but the methods used for conventional imaging were more variable. RESULTS: All studies demonstrated an improved anatomical localization by performing additional SPECT/CT; sentinel nodes outside the axilla or nodes close to the injection site were especially easier to identify. Sentinel nodes were visualized in 89–100% by combined conventional imaging and SPECT/CT, with sentinel nodes depicted only by SPECT/CT in up to 14%. CONCLUSION: It is concluded that SPECT/CT shows the exact anatomical location of sentinel nodes, detects sentinel nodes not depicted by conventional imaging, and therefore facilitates surgical exploration. The hybrid SPECT/CT has the potential to make image fusion a routine clinical tool that improves lymphatic mapping in patients with breast cancer.