CTE Sessions at EANM’14

EANM’14 – CTE Session III

October 20, 2014, 14:30 – 16:00
Challenge and Perspective in Health Care: Nuclear Medicine Role

Chairpersons: M. Federspiel (Copenhagen), A. Shafi (Malmö)

B. Pouw (Amsterdam):
Radioguided Seed Localisation for Non-Palpable Breast Cancer in Breast Conserving Surgery
N. Bruin (Amsterdam):
Lymph Node Scintigraphy Including SPECT/CT for Breast Cancer and other Malignancies
M. Josipovic (Copenhagen):
Respiratory Gated CT Scanning for Radiotherapy Planning of Breast Cancer

Educational Objectives:

  1. To give an overview of techniques for intraoperative localisation of non-palpable breast cancer
  2. An illustration of radioguided seed localisation with I125-seeds
  3. To demonstrate the possibilities and limitations of using I125-seeds for the treatment of breast cancer
  4. To describe how sentinel lymph node scintigraphy could be performed
  5. To identify and localise sentinel nodes using SPECT/CT in addition to planar lymphoscintigraphy
  6. To be aware of the advantages and indications for SPECT/CT in sentinel lymph node scintigraphy in breast cancer and other malignancies
  7. To demonstrate different techniques for respiratory gating on a CT scanner, including inspiration gating and deep inspiration breath-hold
  8. To visualise differences in the presented anatomy during free-breathing and gated CT scans and their impact for the toxicity risk of breast cancer radiotherapy
  9. To be aware of uncertainties in the process of gated imaging and treatment for breast cancer


National breast cancer screening programs increased the incidence of non-palpable radiological suspect lesions up to 25%. At present four different techniques are used for intraoperative localisation of non-palpable breast cancer: wire-, carbon, ultrasound, and radioguided localisation. Radioguided occult lesion localisation (ROLL) and radioguided seed localisation (RSL) are two radioguided localisation techniques and seem to be two reliable alternatives for intra-operative lesion localisation. RSL is introduced and used since 1999 and gaining popularity worldwide. RSL is based on the implantation of an I125-seed in the centre of the tumour. This allows intraoperative localisation by the emission of gamma rays by the surgeon. One of the major advantages of the I125-seed as tumour marker over the ROLL is the half-life time of I125. The half-life time of 60 days allows time between implantation and surgery for further diagnosis or neo adjuvant chemotherapy. During surgery the surgeon resects the tumour including the I125-seed guided by a gamma probe.
Traditionally, lymphoscintigraphy has been used to preoperatively identify sentinel nodes in breast cancer and other malignant tumours. A few years ago SPECT/CT was introduced in nuclear medicine and has been used in some hospitals to anatomically localise sentinel nodes. In this presentation it will be described when sentinel lymph node scintigraphy in breast cancer is required, how it can be done, when additional SPECT/CT is needed and what the advantages are.
Respiratory gated CT scans for radiotherapy planning of breast cancer can be performed in inspiration, either as inspiration gating or as deep inspiration breath hold. Radiotherapy for breast cancer is typically delivered as two opposing tangential fields, encompassing the breast. The lung tissue adjacent to the breast is therefore included in the radiation fields, representing a risk of late lung toxicity. For the left sided breast cancer, the heart may be partially inside the irradiated area as well, resulting in high risk of cardiac toxicity as a late effect of radiotherapy. In deep or moderate inspiration, the total lung volume inflates considerately, reducing the dose to the whole lung, while the heart moves caudally away from the irradiated area and considerably decreases the risk of cardiac toxicity.

Key Words:

Radioguided Seed Localisation (RSL), SPECT/CT, Localise Sentinel Nodes, Respiratory Gated CT Radiation, Reducing Dose to Lung

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