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Table 3

From: Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer

Potential advantages of optimized lymphoscintigraphy

- Reduces morbidity compared to probe only method.

- Reduces short and long term costs of treatment resulting from morbidity.

- Facilitates minimal invasiveness, improving cosmetic results.

- Assists surgeons in planning their approach and harvesting the SN.

- Provides additional guidance for surgeons who are learning the SLNB technique.

- Reduces overall surgical costs (anesthesia time, operating room utilization) by shortening surgery.

- Provides a wide field of view survey covering multiple lymph node basins simultaneously improving staging.

- Diffusion fields emanating from injection sites are defined and assessed for partly hidden nodes by scaling.

- The effects of breast displacement maneuvers are easily assessed.

- Delineates multiple SN nodes, their position and intensity along lymphatic channels, time of appearance.

- Delineates intervening nodes in unexpected positions when prominent lymphatic channels are present.

- Estimates the position of the SNs in the body from triangulated body marking (TBM).

- Surface contamination and other quality control issues are easy to detect and implement.

- Dynamic imaging is possible and its potential benefits in select cases.

- Assesses the intensity of the SN for next day surgery and determines the need for additional injections.

- Alerts to a failed node visualization (tumor replacement) and the possibility of a more extensive ALND.

- Delineates reverse echelon nodes, persistent lymphatic pools/dilations, end-on effects.

- Guides the planning of radiation ports with the inclusion of internal mammary chains when present.

- Sitting views can resolve clumped nodes, not possible with the probe after anesthesia.

- Improved localizing performance in obese patients compared to the probe before incision.

- Reduces the chance of un-harvested SNs (false negatives) through comparisons (numerical/positional/intensity) with images.

Potential disadvantages of lymphoscintigraphy

- Additional cost of procedure.

- Technically effort-intensive to fully optimize.

- Can delay surgery if not scheduled appropriately.

- Additional patient time required and any associated discomfort during imaging.

- Inadequate reimbursement for those performing it.