Standing, Arms Out Position May Reveal More Nodes in Breast...
Standing, Arms Out Position May Reveal More Nodes in Breast...
June 22, 2005 (Toronto) — The position of a patient's arms and whether they are standing or supine can make a big difference in terms of the visibility of sentinel nodes when undergoing lymphoscinitigraphy researchers reported here at the Society for Nuclear Medicine 52nd Annual Meeting.
In fact, patients should stand while the scan is being done and have their arms out in front of them for the best view, said Sunhee Kim, MD, a resident in radiology at Mt. Sinai Hospital in New York.
Dr. Kim presented two studies that evaluated the visibility of sentinel nodes in breast cancer patients while they were imaged in different positions.
Starting more than a year ago, researchers started to perform lymphoscintigraphy of patients in six different positions: standing (both anterior and lateral views) with the arm out and again with the arm up, then again supine (both anterior and lateral views) with the arm out and again with the arm up. A total of 73 women with breast cancer underwent the imaging, after being injected with the imaging agent at the areolar skin junction.
The researchers then counted the number of sentinel nodes seen in each position and noted whether the same number could be seen in scans from different positions. They also measured the distance between the center of the first lymph node and the breast lesion and measured the distance between the first and second nodes.
"Basically what it shows is the arms-out position has better delineation between the nodes," Dr. Kim told Medscape. And having the patient stand during the scan is even better. With arms up, the second node often was not very visible, or it was not clear that there was a second node.
"With the arms out, the breast lesion goes down and moves more inward. So, it goes away and it pulls down the lymph node. That is why the two lymph nodes can be separated more easily," Dr. Kim said.
Standing "significantly has better delineation compared to the supine. If you stand there is gravity, it pulls down the lesion, pulls down the lymph nodes, so it has better separation between the nodes and the lesion," Dr. Kim said.
The better visualization provides more certainty about the number of nodes, and the information can be passed on more confidently to the surgeon, Dr. Kim said.
Centers do tend to have their own way of doing the imaging, agreed Dominick Lamonica, MD, director of nuclear medicine, Division of Diagnostic Imaging at Roswell Park Cancer Institute in Buffalo, New York. Dr. Lamonica was not part of the study group but provided an outside comment.
Dr. Lamonica is not convinced a change in position makes a big difference "as long as the surgeon is directed to the right spot," he said.
At Dr. Lamonica's clinic, the imaging is not done with patients' arms straight up, but with the arm up and with the hand resting behind the head and elbow pointed out.
No commercial funding was reported for this study.
SNM 52nd Annual Meeting: Abstracts 1314, 1315. Presented June 21, 2005.
Reviewed by Gary D. Vogin, MD
June 22, 2005 (Toronto) — The position of a patient's arms and whether they are standing or supine can make a big difference in terms of the visibility of sentinel nodes when undergoing lymphoscinitigraphy researchers reported here at the Society for Nuclear Medicine 52nd Annual Meeting.
In fact, patients should stand while the scan is being done and have their arms out in front of them for the best view, said Sunhee Kim, MD, a resident in radiology at Mt. Sinai Hospital in New York.
Dr. Kim presented two studies that evaluated the visibility of sentinel nodes in breast cancer patients while they were imaged in different positions.
Starting more than a year ago, researchers started to perform lymphoscintigraphy of patients in six different positions: standing (both anterior and lateral views) with the arm out and again with the arm up, then again supine (both anterior and lateral views) with the arm out and again with the arm up. A total of 73 women with breast cancer underwent the imaging, after being injected with the imaging agent at the areolar skin junction.
The researchers then counted the number of sentinel nodes seen in each position and noted whether the same number could be seen in scans from different positions. They also measured the distance between the center of the first lymph node and the breast lesion and measured the distance between the first and second nodes.
"Basically what it shows is the arms-out position has better delineation between the nodes," Dr. Kim told Medscape. And having the patient stand during the scan is even better. With arms up, the second node often was not very visible, or it was not clear that there was a second node.
"With the arms out, the breast lesion goes down and moves more inward. So, it goes away and it pulls down the lymph node. That is why the two lymph nodes can be separated more easily," Dr. Kim said.
Standing "significantly has better delineation compared to the supine. If you stand there is gravity, it pulls down the lesion, pulls down the lymph nodes, so it has better separation between the nodes and the lesion," Dr. Kim said.
The better visualization provides more certainty about the number of nodes, and the information can be passed on more confidently to the surgeon, Dr. Kim said.
Centers do tend to have their own way of doing the imaging, agreed Dominick Lamonica, MD, director of nuclear medicine, Division of Diagnostic Imaging at Roswell Park Cancer Institute in Buffalo, New York. Dr. Lamonica was not part of the study group but provided an outside comment.
Dr. Lamonica is not convinced a change in position makes a big difference "as long as the surgeon is directed to the right spot," he said.
At Dr. Lamonica's clinic, the imaging is not done with patients' arms straight up, but with the arm up and with the hand resting behind the head and elbow pointed out.
No commercial funding was reported for this study.
SNM 52nd Annual Meeting: Abstracts 1314, 1315. Presented June 21, 2005.
Reviewed by Gary D. Vogin, MD
Source...