- Integrating new imaging modalities in breast cancer management
M.J.T.F.D. Vrancken Peeters
- Award date
- 27 May 2016
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
This thesis aimed to integrate new imaging modalities in breast cancer management. In Part 1 the focus was to assess the current status of radioactive seed localisation (RSL) in clinical practice. Both patients as well as physicians or surgeons rated the technique superior compared to the conventional techniques. It is our expectation that when legislation is simplified and standard protocols for this procedure are available the adaptation rate of this procedure will further increase since legislation is currently the bottleneck in clinical implementation. This part also proposes a safe protocol for combined RSL and sentinel node (SN) procedures.
Part 2 continued with a radioguided method, freehand-SPECT, to improve intraoperative navigation towards radioactively stained lesions. Freehand-SPECT was used to guide preoperatively ¹²⁵I-targeted 99mTc-albumin nanocolloid administrations used for the SN procedure and in a different study during breast cancer surgery.
Part 3 was about the consequences of the relatively new indications for SN procedures in recurrent breast cancer and the role of SPECT/CT imaging for this these procedures. This evaluation demonstrated that the current SN protocols for the new indications (recurrent breast cancer and neoadjuvant systemically treated breast cancer) that receive a SN procedure were inadequate. Further optimisation of institutional protocols may lead to more adequate patient tailored handling for the SN procedure. We conclude that a standard SPECT/CT scan after non-visualisation on planar imaging is not as useful as previously was assumed. Fortunately, intraoperative SN identification rates remain high for patients with non-visualisation when primary surgery was performed.
- Research conducted at: Netherlands Cancer Institute AvL
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