The use of single-photon emission computed tomography-computed tomography in detecting multiple metastatic lymph nodes in patients with breast cancer.

AIM: The aim of the present study was to determine the accuracy of single-photon emission computed tomography-computed tomography (SPECT-CT) with technetium-99m-sestamibi (Tc-MIBI) for detecting multiple (>2 nodes) axillary lymph node involvement in patients with breast cancer (BC). PATIENTS AND METHODS: A total of 184 women with BC were examined. Clinically, axillary lymph nodes were classified as N0 in all cases. Patients underwent SPECT-CT breast and axillary region imaging 10-15 min after a 740 mBq intravenous injection of Tc-MIBI. SPECT-CT data were then verified by definitive histopathological examination (sentinel-node biopsy and/or axillary lymph node dissection were used as reference standard). Diagnostic values of different CT and SPECT signs of multiple (>2) lymph node involvement were evaluated. RESULTS: Histological examination of excised lymph nodes showed metastatic involvement in 62 (33.7%) out of 184 patients. In fact, 25 (13.6%) patients had more than two lymph node involvements. In another 37 (20.1%) cases the metastasis was revealed in one or two sentinel lymph nodes only. The main SPECT-CT criteria of multiple (>2) lymph node involvement were as follows: the maximum size of the primary tumor (>20 mm), lymph node dimensions (>12 mm along the long axis and >10 mm along the short axis), nodal cortical thickness (>4 mm), round shape, solid structure, quantity of identified abnormal lymph nodes (>1), and intensity of tracer uptake. The developed integrated model offers the possibility to exclude multiple lymph node metastasis (>2) in BC patients with a probability of 99%. CONCLUSION: This single-center study showed that in patients with BC, a combination of functional and anatomical data that were obtained by using SPECT-CT with Tc-MIBI can significantly improve detectability of multiple (>2) axillary metastases.

Technetium-99m methoxyisobutylisonitrile scintimammography for monitoring and early prediction of breast cancer response to neoadjuvant chemotherapy.

PURPOSE: The aim of the study was to evaluate the clinical value of scintimammography (SMG) with technetium-99m methoxyisobutylisonitrile (Tc-MIBI) for evaluating the efficacy of neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: A total of 65 patients with advanced breast cancer (BC) were included in the study. Planar SMG with 740 MBq of Tc-MIBI was performed before the start and after two to three and four to six cycles of NAC. NAC efficacy was estimated as progression (grade I), stabilization (grade II), partial effect (grade III), prominent efficacy (grade IV), and complete response (grade V). In 59 women, histopathologic verification of BC response to NAC was performed according to the Miller-Payne classification with the same scores as were used in the evaluation of scintigraphic response. RESULTS: After two to three cycles of NAC, disease progression was detected in five of 65 (7.7%) patients. In 27 (41.5%) patients SMG detected early stabilization of BC. Only one of these patients achieved prominent (grade IV) response after the end of NAC. Partial (grade III) response after two to three cycles of NAC was seen in 24 (36.9%) patients. One-third of them had grades IV-V response at the end of treatment. The most promising was the group of nine (13.8%) patients with early-grades IV-V response, all of which transformed to complete response at the end of NAC. As per histopathologic verification, early SMG had 85.7% sensitivity, 94.2% specificity, and 93.2% accuracy in predicting complete pathologic response to four to six cycles of NAC. CONCLUSION: After two to three cycles of NAC, SMG with Tc-MIBI can determine patients with low, intermediate, and high probability of complete response to five to six cycles of NAC Video Abstract: http://links.lww.com/NMC/A43.

The Utility of 3-Dimensional-Navigation in the Surgical Treatment of Children With Idiopathic Scoliosis.

STUDY DESIGN: Ambispective study of patients undergoing surgical correction of adolescent idiopathic scoliosis. OBJECTIVE: To evaluate the accuracy of screw placement using preoperative 3-dimensional (3D) computed tomography (CT)-based navigation with intraoperative fluoroscopic guidance compared with freehand placement. SUMMARY OF BACKGROUND DATA: Pedicle screws placed in deformed vertebrae have a high malposition rate. The use of navigation-based systems has increased placement accuracy. METHODS: Intraoperative registration of patient anatomy to preoperative 3D-CT was performed using anatomic landmarks. When registration accuracy was high (mean square error, <1.0 mm), screw tracts were drilled under navigation guidance; when the error was >1.0 mm, re-registration was performed. The researchers documented times for registration, navigation, and screw placement, and the number of passes. Results were compared with outcomes in cases operated on with freehand screw placement. RESULTS: A total of 62 patients were included (54 females and 8 males; mean age was 15.1 years [range, 12-18 years]). Mean deformity was 67° (range, 52° to 80°). Mean follow-up was 35 months (range, 42-19 months). In the navigation group, 710 pedicle screws were placed. Mean times were 55 seconds for tracker placement, 94.5 seconds per vertebra for patient registration, 131.1 seconds for screw tract formation on the concave side of the deformity, and 129.5 seconds on the convex side. Average total procedure time was 3.5 hours (range, 2-7 hours). Mean overall registration accuracy was 0.7 mm. Pedicle integrity was breached in 1.6% trajectories. In the freehand group, 470 pedicle screws were placed. Average time for screw placement was 135.2 seconds (p < .001 vs. navigation). Pedicle integrity was breached in 5.1% of trajectories (p < .0001 vs. navigation). No patient developed neurological or other complications. There was no destabilization of the instrumented spine during short- or long-term follow-up. CONCLUSIONS: Intraoperative optic fluoroscopic navigation based on anatomic landmark registration to preoperative 3D-CT spine images enables precise pedicle screw placement with only a minor increase in pedicle preparation time in patients with adolescent idiopathic scoliosis.