Potential advantages of optimized lymphoscintigraphy |
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- 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. |