Comparing techniques to map breast cancer sentinel lymph nodes

Start Year: 2010
Finish Year: 2012
Chief Investigator: Dr Farnoush Noushi
Grant Type: Pilot Study
Institution: University of Sydney

Pilot Study Grant

The project compares two internationally established but different lymphoscintigraphy techniques in breast cancer. Accurate lymphoscintigraphy is the first step in establishing the ‘road map’ of lymphatic anatomy in the breast cancer patient. This helps target sentinel node biopsy achieve accurate staging and guide appropriate adjuvant therapy. If there were a significant discordance between the two different lymphoscintigraphies then this would highlight significant error in the utility that has not been previously documented.

Two different injection techniques (peri-areolar and peri-tumoural) of radiolabelled tracer are utilised by international centres, however they have never been directly compared side to side in the same patients, especially with the advent of high resolution SPECT/CT scanning (which combines traditional nuclear medicine SPECT images with improved anatomical resolution of a CT scanner).

Dr Noushi proposes a pilot study that directly compares the two techniques of lymphoscintigraphy on 20 patients. These will be performed sequentially, the second being the locally established practice to guide subsequent standard breast cancer treatment in all patients. Degree of variation in sentinel node mapping will be analysed using SPECT/CT technology. This project would potentially establish the ‘gold standard’ for lymphoscintigraphy by direct comparison; consequently it would help develop practice guidelines and uniformity in practice globally.