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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.