Improved body-outline imaging technique for localization of sentinel lymph nodes in breast surgery.

Abstract

Many centers use techniques for localizing the sentinel lymph node (SLN) associated with a breast tumor. Protocols involve the use of an intraoperative probe and blue dye but may or may not include scintigraphy. Three methods of body-outline imaging were investigated to aid SLN localization. Body outlines were acquired using a handheld source; a transmission image was acquired from a (57)Co-flood source; and, finally, a new method is described using a (153)Gd-line source attenuation correction for body outline. Method 1 images were of low quality, although 83% of SLNs were visualized. Body outline was unsatisfactory for surgical localization. Method 2 was unsatisfactory because of the lack of a lateral image. Method 3 enabled good presurgical visualization of the SLN (73%) and speeded surgical localization. The (153)Gd-line source consistently gives optimal-quality body-outline images. This source is simple, quick, and clearly locates the SLN on multiple projections.