this may be due to shared lymphatic drainage between the breast and upper limb in this group of patients, and the aim of this study was to investigate the extent of the similarity between the axillary lymphatic drainage basins of the breast and upper limb. Methods Patients with breast cancer due to undergo axillary lymph node dissection were injected pre-opera- tively with 40 MBq of 99m Tc-human immunoglobulin (HIG) intradermally into the peri-areolar region of the ipsilateral breast and 3 MBq of 111 In-HIG intradermally into the dorsum of the ipsilateral hand, or vice versa. Axillary lymph nodes were removed, separated, and well- counted for the presence of 99m Tc and 111 In. Results In all, 15 patients were entered into the study. In 13/15 patients the ‘hottest’ lymph node for 99m Tc was different from the ‘hottest’ lymph node for 111 In. In 2/15 patients the ‘hottest’ lymph node for 99m Tc was also the ‘hottest’ lymph node for 111 In suggesting a common drainage pathway for the ipsilateral breast and upper limb. Conclusion Whilst the majority of patients have different pathways of lymphatic drainage for the ipsilateral breast and upper limb, in some patients the drainage pathway is through a common sentinel lymph node. These patients may be at increased risk of developing lymphoedema when undergoing SLNB. A30 Correlation of tumour histology with tumour to background ratio in 99m Tc-depreotide SPECT imaging of the lung G. Ainslie, A. Bolster and J.B. Neilly Glasgow Royal Infirmary, UK. Aim To determine the effectiveness of a measure of tumour to background ratio (T:B) as a quantification tool in 99m Tc-depreotide SPECT imaging. Method The raw data were reconstructed using iterative reconstruction followed by a post reconstruction low pass filter. Values of T:B were obtained from the transverse slices by defining a region of interest around the site of the tumour and around a region of normal lung uptake (background region: same slice and lung). In cases where the tumour site was too large, background regions were defined in the contra-lateral lung. Results Case notes of 24 patients undergoing NeoS- PECT scanning were reviewed. To date, histology was available in 12 patients, 9 of whom (group 1) had non- small-cell lung cancer (NSCLC); and 3 (group 2) had benign histology (TB, organizing pneumonia, bronchiec- tasis). The mean T:B for group 1 was 2.14 while the mean T:B for group 2 was 2.09. Due to small numbers statistical comparison was not possible. Conclusion The results demonstrate that T:B ratios for NeoSPECT uptake in the primary NSCLC lesions is of the magnitude of approximately 2:1. These results are similar in magnitude to those lesions with benign histology. A31 Longitudinal follow-up of patients with medullary thyroid cancer R. Karugaba and S.E.M. Clarke Department of Nuclear Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK. Background Medullary thyroid cancer (MTC) is rare. Its behaviour is usually indolent and calcitonin levels may be elevated for a number of years before imaging identifies the site(s) of recurrence Aim To determine the value of combined planar and tomographic radionuclide imaging with 99m Tc(V)-dimer- captosuccinic acid ( 99m Tc(V)-DMSA) and 111 In-octreo- tide in the longitudinal follow-up of patients with MTC. Method Scan results were reviewed in 19 patients (17 female, 2 male, mean age 68 years). Seventy combined studies were performed over a mean period of 7.5 years (range 1–18 years). Studies were repeated at 6-month intervals if calcitonin levels were rising rapidly and at 1- year intervals if calcitonin levels were elevated but plateaued or rising slowly. Results Twenty-eight (37.3%) combined studies were abnormal and, similarly, 28 (37.3%) were negative. In 15 (20%) combined studies the 99m Tc(V)-DMSA alone was positive and in 4 ( 5.3%) the 111 In-octreotide alone was positive. In 11 99m Tc(V)-DMSA and 7 111 In-octreotide studies the tomographic study alone was positive. In 13 patients, the combined studies became positive during the course of follow-up. Conclusion Combined imaging with planar and tomo- graphic 99m Tc(V)-DMSA/ 111 In-octreotide identified sites of recurrent disease in 62.7% of follow-up studies performed. Radionuclide imaging provides an effective method of monitoring MTC patients with biochemical evidence of relapse. A32 Experience with 90 y-ibritumomab (zevalin) in the management of refractory non-hodgkin’s lymphoma S. Han a , A.H. Iagaru b , H.J. Zhu b and M.L. Goris b a Nuclear Medicine Department, Glasgow Royal Infirmary, UK, and b Nuclear Medicine Department, Stanford University Medical Centre, California, USA. Introduction Radioimmunotherapy has been shown to be an effective treatment for refractory non-Hodgkin’s lymphoma (NHL). We present our experience with Zevalin, a radiolabelled monoclonal antibody targeting CD20, in the management of refractory NHL. Patients and methods The case records of 25 patients (19 male, 6 female; mean age 57 years, range 36–85 years), who had outpatient Zevalin therapy in 2000–2005 for refractory NHL were reviewed retrospectively. Types of NHL were follicular/mixed follicular (12), mantle cell (9), marginal zone/MALT (2), diffuse large cell (1) and immunoblastic (1). Patients were preloaded with Ritux- imab (250 mgÁm –2 ) on days 0 and 7, followed by diagnostic 111 In 185 MBq (5 mCi) on day 0 and ther- 1022 Nuclear Medicine Communications 2006, Vol 27 No 12 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.