Chair for Computer Aided Medical Procedures & Augmented Reality
Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality

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I. Santi, L. Fantini, K. Herrmann, Ch. Fuccio, T. Wendler, P. Caroli, P. Castelucci, S. Nicolini, A. K. Buck, M. Schwaiger, S. Fanti
Freehand SPECT 3D-imaging for sentinel lymph node mapping in breast cancer: preliminary preoperative study for future intraoperative use in the operating room
Proceedings of the International Sentinel Node Society Meeting, Yokohama, Japan, 2010 (bib)

To evaluate freehand SPECT (FH) sensitivity and accuracy in the detection and localization of sentinel lymph-node SLN) in patients with breast cancer, in order to validate the technique for its use in the operating room.
116 consecutive patients (64 studied at Policlinico S.Orsola-Malpighi, University of Bologna, Italy; 52 studied at Technische Universität München, Germany) affected by invasive breast cancer cT1-c T2, already scheduled for surgery, underwent standard lymphatic mapping (intradermal administration of 48-80 MBq of Tc-9 9m nanocoll). Subsequently patients were scanned using a FH system (prototype of CSS300 by SurgicEye? GmbH?).
The position and orientation of a gamma probe is acquired simultaneously with its reading using an optical positioning system. After a free hand scan containing the ROI, 3D images are reconstructed using ad hoc models.
FH results (number and localization of the sentinel LN) were compared for reference with standard Planar Scintigraphy (PS).
In all patients PS mapped at least one LN in the axilla, while FH managed to identify at least one LN in 111 out of 116 patients resulting in 96% sensitivity and accuracy. Overall PS detected 184 LN, while FH identified 157/184 LN (sensitivity and accuracy: 85%). FH was false negative in 27/184 sentinel LN in 20 patients.
In 6 patients FH was able to detect 6 LN that were not detected by PS. In 5 patients FH did not show any focal uptake probably because the LN was too close to the injection site .False negative results at FH (27 LN) were probably due to low tracer migration to sentinel LN, insufficient scanning time or too close LN that ended up merging.
These preliminary data show that FH technology is able to localize sentinel LN in the axilla adding 3D information that could be potentially useful in the operating room. Given this added value, further applications of FH technique could be the sentinel LN mapping in more complex basins like neck and groin in melanoma, and abdomen and pelvis in vulvar and cervical cancers. This could help surgeons for an easier 3D-image guided sentinel LN dissection.
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