Status of sentinel lymph node for breast cancer.

Long-awaited results from randomized clinical trials designed to test the validity of sentinel lymph node biopsy (SLNB) as replacement of axillary lymph node dissection (ALND) in management of early breast cancer have recently been published. All the trials conclude SLNB has survival rates comparable to those of ALND (up to 10 years in one study) and conclude SLNB has less morbidity than ALND. All the trials support replacing ALND with SLNB for staging in early breast cancer; all support SLNB as the standard of care for such cancer. The SLNB protocols used in the trials varied, and no consensus that would suggest a standard protocol exists. The results of the trials and of other peer-reviewed research do, however, suggest a framework for including some specific methodologies in accepted practice. This article highlights the overall survival and disease-free survival data as reported from the clinical trials. This article also reviews the status of SLN procedures and the following: male breast cancer, the roles of various imaging modalities (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, and ultrasound), ductal carcinoma in situ, extra-axillary SLNs, SLNB after neoadjuvant chemotherapy, radiation exposure to patients and medical personnel, and a new radiotracer that is the first to label SLNs not by particle trapping but by specific macrophage receptor binding. The proper Current Procedural Terminology (CPT) code for lymphoscintigraphy and SLN localization prior to surgery is 78195.

Incremental benefit of SPECT + CT bone scans over conventional planar and SPECT bone scans in vertebroplasty.

STUDY DESIGN: Planar bone scans with SPECT and SPECT + CT were performed in those patients who underwent peri-operative evaluation for vertebroplasty. The scans were evaluated separately to identify the "culprit" vertebra (e) by two readers and their results were analyzed. OBJECTIVE: Use of planar and SPECT bone scan for identifying the "culprit" vertebra (e) for vertebroplasty is well established. SPECT + CT is a relatively recent imaging tool providing co-registered fused images. Theoretical advantages of SPECT + CT over conventional SPECT imaging needs to be evaluated and documented. SUMMARY OF BACKGROUND DATA: Percutaneous stabilization of collapsed vertebra by bone cement has now become a standard procedure. However, it is essential to localize the correct vertebra. Imaging modalities like CT scan provides structural or anatomical information where as bone scan (planar + SPECT images) provides more functional or physiological information. Combination of these two imaging modalities is expected to provide much more than information obtained by any one imaging modality separately. To the best our knowledge, there is no reference available in the literature adopting this approach. MATERIALS AND METHODS: Two expert readers, blinded to patient history, evaluated the scans. They independently analyzed planar + SPECT only images followed by SPECT/CT fused images with the aim to identify the acutely fractured vertebra for vertebroplasty. RESULTS: Interpretations changed, on average, 50% of the time as a result of the additional information provided by SPECT + CT. SPECT + CT more precisely localizes tracer abnormalities in the vertebra compared to SPECT imaging alone. CONCLUSION: The greatest value of co-registered SPECT + CT bone scan lies in the accurate localization of affected vertebrae in complicated cases of multiple collapsed vertebrae of different ages as well as in the post-vertebroplasty setting.