Early-stage Breast Cancer Clinical Trial
Official title:
Role of Sentinel Lymph Node Identification in Patients With Breast Cancer Using SPECT/CT
Role of SPECT/CT in detection of sentinel lymph node in patients with breast cancer that is in early stage with small mass with no nodal or distant metastasis using radioactive material nannocolloid that can change surgical approach
The status of axillary lymph node involvement is the best prognostic factor in patients with
early stage breast cancer. In the past; removal of all of the axillary lymph nodes (axillary
lymph node dissection, ALND) was often the preferred method of treatment.
ALND, however, has significant short- and long-term morbidity, the most significant being
lymphoedema. With the trend towards earlier detection and presentation of breast cancer, most
patients do not have lymphatic metastases at diagnosis.
In these patients, ALND is purely a diagnostic procedure, with no therapeutic benefit;
besides the widespread use of breast conserving surgery, the staging procedure carries
greater morbidity than the therapeutic procedure of the primary cancer.
Sentinel lymph nodes (SLNs) are defined as the first lymph nodes in a tumor bed that receive
lymphatic drainage directly from the primary tumor; accordingly these nodes are most likely
to harbor metastasizing cancer cells along the path of lymph drainage of tumor tissues, if
lymphatic metastasis does occur.
SLN biopsy (SLNB) has been demonstrated to be an ideal option to accurately stage axillary
nodal involvement in breast cancer; it is a minimally invasive technique for lymphatic
staging. The accurate detection of the SLN is paramount for the success of the procedure.
SLNB in patients with clinically node-negative breast cancer is a valuable procedure for
nodal staging ,treatment selection guiding, and often spares patients from the potentially
devastating side effects of ALND such as lymphedema while maintaining the curative effect of
surgery.
Although being an important element in identification of SLNs; interpretation of planar
lymphoscintigraphy is hindered by the absence of anatomical landmarks in the scintigraphic
image.
Single photon emission computed tomography coupled with computed tomography (SPECT/CT) was
introduced in lymphatic mapping with the goal to show more SLNs and to show them more clearly
than is possible with planar lymphoscintigraphy to improve nodal staging.
Besides providing functional scintigraphic information, it provides accurate anatomical
localization. This advantage facilitates surgical exploration.
SPECT/CT can detect additional nodes not visualized on planar images and is especially useful
in visualization of SLN outside the axilla or nodes close to the injection site.
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