Keywords
neoadjuvant chemotherapy
sentinel lymph node biopsy (SLNB)
SPECT-CT
How to Cite
Abstract
Aim. To evaluate the potential of SPECT-CT imaging for improving the diagnostic yield of sentinel lymph node biopsy (SLNB) in breast cancer (BC) patients following neoadjuvant systemic therapy (NAST).
Materials and Methods. The study included 24 patients with cT1–T3N1 BC who achieved a clinical complete response (ycT0-1, ycN0) after NAST. Prior to NAST, all patients underwent SPECT-CT with the tumor-seeking radiopharmaceutical (RP) 99mTc-methoxy-isobutyl-isonitrile (MIBI, "Technetril") to localize metastatic axillary lymph nodes (LNs). The study was performed according to the standard protocol 20 minutes after intravenous administration of 500 MBq of 99mTc-MIBI. After NAST, patients with a complete clinical response in the lymph nodes (ycN0) underwent repeat SPECT-CT with 99mTc-labeled colloids ("Sentiscan") for SLN mapping. SPECT-CT of SLNs was performed according to the standard protocol following the injection of 0.1–0.2 mL (100–150 MBq) of 99mTc-Sentiscan into the tumor bed and subareolarly. The topography and number of SLNs were determined on SPECT-CT. Based on the SPECT-CT data, we analyzed the concordance/discordance between the localization of SLNs after NAST (SPECT-CT with 99mTc-colloid) and the metastatic LNs before NAST (SPECT-CT with 99mTc-MIBI). Axillary lymph node status was verified histologically via targeted axillary dissection, with assessment of pathologic treatment response (ypN0/ypN+).
Results. SPECT-CT with 99mTc-MIBI identified 1–3 metastatic LNs in all patients. After NAST, all patients achieved clinical complete nodal response (ycN0). SLNs were visualized on post-NAST SPECT-CT with 99mTc-colloids in 100 % patients. Comparative topographic analysis revealed discordance between the location of post-NAST SLNs and pre-NAST metastatic LNs in 29 % (7/24) of cases. Concordance was observed in the remaining 71 % (17/24) of cases, suggesting that SLN removal and morphological analysis in this subgroup would more accurately reflect true axillary LN status after NAST.
Conclusion. The use of SPECT-CT with 99mTc-MIBI before NAST and with 99mTc-colloids after NAST enables identification of a subgroup of BC patients in whom SLNB for axillary restaging would be most informative.
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Copyright (c) 2026 Павел Иванович Крживицкий, Сергей Николаевич Новиков, Сергей Васильевич Канаев, Всеволод Вячеславович Данилов, Петр Владимирович Криворотько, Жанна Викторовна Брянцева, Надежда Сергеевна Попова, Алина Алексеевна Хорошавина, Анна Сергеевна Артемьева