By Hayley Crosby
The National Cancer Institute says 12.3 percent of all women will be diagnosed with breast cancer at some point during their lives. In 2014 alone, there will be more than 230,000 new cases. Thanks in part to the efforts made during National Breast Cancer Awareness Month, however, nearly nine out of every ten women are expected to survive a breast cancer diagnosis.
While mammograms are widely accepted as the best test for the detection and prevention of breast cancer, other advances in medical technology have also played a key role in increasing a patient’s chances of survival. One of these is a simple radiological test with a complicated name: lymphoscintigraphy.
Doctors order this imaging test before surgically removing a tumor to be sure the cancer hasn’t spread beyond the breast. A patient has a much greater chance of survival when a cancer can be detected early. Cancers have long been categorized into stages when planning a course of treatment. Stage I, “Localized” means that the cancer is only where it was initially discovered. Stage II, “Regionalized” is when it has gotten into the lymph nodes, which can take it to other parts of the body, leading to Stage III (“Distant”) and Stage IV (“Unknown”).
With lymphoscintigraphy, we’re hoping to find the cancer before it gets beyond Stage Two. A patient’s survival rate is 98.5 percent when breast cancer is detected during Stage One. At Stage Two, it drops to 84.6 percent, but after that the survival rate plummets to 25 percent.
Before this imaging technique, physicians would consistently have to perform a surgical procedure called a lymphatic dissection. Lymphoscintigraphy gives physicians another option that is much less invasive. A small amount of radioactive material called a radiopharmaceutical is injected just under the skin to the side of the areola on the breast. This material helps the surgeon, with the aid of a nuclear medicine camera; locate the particular lymph node where the tumor might begin to spread. This is called the sentinel node. Once identified, the sentinel node can be biopsied to determine whether the cancer has spread outside the breast.
The patient has to wait about an hour for the radiopharmaceutical to work its way into the lymph nodes before imaging with a gamma camera can begin. The gamma camera is able to detect the radiopharmaceutical that was injected earlier. A technologist will spend roughly 20 minutes taking images from different angles, looking for the sentinel node. This is different than other imaging tests, where we hope nothing shows up on the scan. Here we want to see radiopharmaceutical uptake in the sentinel node, but even if it doesn’t the surgeon can also locate it with a Geiger counter.
Here at BMH, lymphoscintigraphy of breast patients is common. We do everything we can to keep the patient comfortable throughout the process. A numbing cream is applied to the injection area, and we also inject a mixture of sodium bicarbonate and lidocaine to further minimize any potential pain. The lights in the room stay dimmed and we have warm blankets to help patients relax. No special preparations are needed, like fasting, before having the scan. Everyone who undergoes this exam tells us their experience was much easier than they expected. Our goal at Brattleboro Memorial Hospital is to give quality patient care close to home. If you or your doctor has any questions about our facility or the lymphoscintigraphy test, please don’t hesitate to get in touch with us.
Hayley Crosby is the Lead Nuclear Medicine Technologist & Diagnostic Coordinator at Brattleboro Memorial Hospital. She can be reached at 802-251-8408.