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First demonstration of 3-D lymphatic mapping in breast cancer using freehand SPECT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Freehand SPECT is a 3-D tomographic imaging modality based on data acquisition with a hand-held detector that is moved freely, in contrast to conventional, fixed gamma camera systems. In this pilot study, the feasibility of freehand SPECT for 3-D lymphatic mapping in breast cancer was evaluated.

Methods

A total of 85 patients (age: 29–88 years) with an initial diagnosis of invasive breast cancer and no clinical evidence of nodal involvement prospectively underwent sentinel lymph node (SLN) biopsy. Preoperative lymphatic mapping (35–87 MBq 99mTc-Nanocoll) included tomographic imaging with a SPECT/CT device (Siemens Symbia T6) serving as reference. Initially, the freehand SPECT approach was assessed in a pilot study consisting of 50 patients. The quality of each freehand SPECT acquisition was assessed and ranked as good, intermediate or poor. In another series comprising a further 35 patients (validation study), a guidance system for the acquisition was implemented based on the results of the pilot study, ensuring acquisitions with good quality. For 3-D tomographic image reconstruction, ad hoc models and iterative reconstruction algorithms were used in all 85 patients. To allow for adequate comparison, SPECT/CT data and freehand SPECT data were registered within the same coordinate system.

Results

In the pilot study, freehand SPECT enabled mapping of 24 of 83 SLNs in 20 of 44 patients (3 dropouts, 3 patients without SLN either in SPECT/CT or in freehand SPECT). Using SPECT/CT as reference, the accuracy of freehand SPECT was 77.8% (7/9 nodes) in scans with good quality, while for intermediate and poor quality scans, the accuracy was reduced to 34.3 and 12.8%, respectively. In the validation study, quality feedback improved the results significantly and freehand SPECT enabled the mapping of at least one SLN in 87.5% of the patients (28/32 − 3 dropouts). Compared to the reference method, freehand SPECT showed a sensitivity of 83.3% (35/42 nodes). False-negative findings were related to insufficient scanning time, insufficient coverage of the axillary region, close proximity of the SLN to the injection site and low tracer uptake in the SLNs.

Conclusion

In this preliminary study, we could demonstrate that 3-D localization of SLNs is feasible using freehand SPECT technology. Prerequisites for acquisition of a good scan quality, most likely allowing precise SLN mapping, have been defined. This approach has high potential to allow image-guided biopsy and further standardization of SLN dissection, thus bringing 3-D nuclear imaging into the operating room.

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Acknowledgement

This research was partially funded by the SFB 824 of the Deutsche Forschungsgesellschaft (DFG), the Graduate School of Information Science in Health (GSISH) and the TUM Graduate School (TUM-GS).

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Authors and Affiliations

  1. Chair for Computer Aided Medical Procedures (CAMP), Technische Universität München, Boltzmannstr. 3, 85748, Garching bei Muenchen, Germany

    Thomas Wendler, Tobias Lasser, Joerg Traub, Olivier Kutter & Nassir Navab

  2. Department of Nuclear Medicine, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    Thomas Wendler, Ken Herrmann, Tobias Lasser, Klemens Scheidhauer, Markus Schwaiger, Sibylle I. Ziegler & Andreas K. Buck

  3. Department of Obstetrics and Gynecology, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Andreas Schnelzer, Alexandra Ehlerding & Marion Kiechle

  4. Institute of Medical Statistics and Epidemiology (IMSE), Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Tibor Schuster

Authors
  1. Thomas Wendler
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  2. Ken Herrmann
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  3. Andreas Schnelzer
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  4. Tobias Lasser
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  5. Joerg Traub
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  6. Olivier Kutter
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  7. Alexandra Ehlerding
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  8. Klemens Scheidhauer
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  9. Tibor Schuster
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  10. Marion Kiechle
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  11. Markus Schwaiger
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  12. Nassir Navab
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  13. Sibylle I. Ziegler
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  14. Andreas K. Buck
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Corresponding author

Correspondence to Thomas Wendler.

Additional information

Thomas Wendler and Ken Herrmann contributed equally to the manuscript.

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Wendler, T., Herrmann, K., Schnelzer, A. et al. First demonstration of 3-D lymphatic mapping in breast cancer using freehand SPECT. Eur J Nucl Med Mol Imaging 37, 1452–1461 (2010). https://doi.org/10.1007/s00259-010-1430-4

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  • DOI: https://doi.org/10.1007/s00259-010-1430-4

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