The impact of nonvisualization of sentinel nodes on lymphoscintigraphy in breast cancer.
ABSTRACT This study aimed at evaluating the relationship between the nonvisualization of sentinel nodes (SNs) at lymphoscintigraphy and the intraoperative detection rate, radioactive counts in vivo, and histological status of SNs.
Two hundred eighty patients with infiltrating breast carcinoma (T0, T(1)/T(2)) underwent preoperative lymphoscintigraphy before gamma probe-guided SN biopsy.
The surgical identification rate with a gamma probe was 84.6% (56 of 280) in lymphoscintigraphy-negative patients and 93.2% (224 of 280) in lymphoscintigraphy-positive patients (P < .05) after two subdermal periareolar injections. The average number of SNs per patient was 1.7 in lymphoscintigraphy-negative patients and 2.2 in lymphoscintigraphy-positive patients (P < .01), as assessed by gamma detection. The mean age of lymphoscintigraphy-negative patients was 62 +/- 10 years, versus 55 +/- 13 years for lymphoscintigraphy-positive patients (P < .001). The median radioactive count in dissected SNs identified by gamma detection was 204 cps (range, 4-618 cps) in lymphoscintigraphy-negative patients, versus 606 cps (range, 43-16,928 cps) in lymphoscintigraphy-positive patients (P < .001). The rate of macrometastatic SNs was 40% in lymphoscintigraphy-negative patients, versus 30% in lymphoscintigraphy-positive patients (not significant), whereas the size of involved SNs was 16.6 mm in lymphoscintigraphy-negative patients, versus 13.1 in lymphoscintigraphy-positive patients (P < .05). The micrometastasis detection rate in SNs from lymphoscintigraphy-negative patients was 6.25%, versus 23.3% in lymphoscintigraphy-positive patients (P < .01).
Negative lymphoscintigraphy was observed in 20% of patients and was more frequent in elderly patients. Negative lymphoscintigraphy was predictive of a lower surgical identification rate and fewer detected SNs. These SNs had fewer micrometastases, were fairly large, and tended to harbor metastases.
- SourceAvailable from: Frank Zarb[Show abstract] [Hide abstract]
ABSTRACT: PurposeThe sentinel lymph node biopsy (SLNB) concept using the cutaneous (subdermal) peri-areolar approach is rapidly emerging as the technique for axillary staging in breast cancer. The procedure indicates whether axillary lymph node dissection (ALND) is necessary, therefore drastically minimising the invasiveness of surgical treatment. The SLNB concept is based on evidence suggesting that malignant disease primarily affects the sentinel node (SN) before being disseminated into the axillary lymph nodes (ALNs).Objective This study was to define the role of lymphoscintigraphy in the visualisation of SNs during SLNB and to establish the correlation between the number of SNs identified on lymphoscintigraphy to the number of surgically identified SNs.Method The study was a non-experimental, correlation study utilising quantitative data. Lymphoscintigraphy reports and histology results of 55 female breast cancer patients who underwent SLNB with partial or total back-up ALND, were retrospectively evaluated.ResultsA maximum of 2 and a minimum of 0 sentinel nodes were visualised on lymphoscintigraphy in 52 out of 55 patients. Successful lymphoscintigraphy was highly predictive (p ≤ 0.001) of a successful SLNB as all 52 patients (94.5%) proceeded to have successful SN/s identification. There was a significant association (p ≤ 0.05) between the number of SN/s visualised on lymphoscintigraphy and the number of SN/s identified during SLNB. Lymphoscintigraphy accurately predicted the number of surgically identified SNs in 50.91% of cases (28/55).Conclusion Considering that successful imaging effectively assures SN identification, the routine use of lymphoscintigraphy using the subdermal peri-areolar approach is fundamental in the reliable performance of SLNB.Radiography 02/2012; 18(1):9–14.
- [Show abstract] [Hide abstract]
ABSTRACT: Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification.Gynecologie Obstetrique & Fertilite - GYNECOL OBSTET FERTIL. 01/2008; 36(7):808-814.
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction Systematical lymphadenectomy has been replaced by selective sentinel node biopsy in the initial staging of early breast cancer. The aim of this study was to assess the accuracy of the technique in its application phase, paying special attention to the follow-up of patients with negative sentinel node who did not undergo axillary lymphadenectomy. Patients and method A total of 168 patients with 169 stage I and II breast cancer lesions underwent sentinel lymph node biopsy in its application phase. The procedure was previously validated by our group and included lymphoscintigraphy performed with periareolar or intratumoral injection of 99mTc stannous colloid, and radioguided surgical detection on the following day. Results Lymphoscintigraphic sentinel node localization was successful in 95.3% of the lesions (161/169) and axillary surgical detection in 90.5% (153/169), with 1.1 nodes excised per patient (range 1-4). Malignancy was found in 30.1% of the sentinel nodes removed (46/153), 11 of which were micrometastases (23.9%). Subsequent axillary dissection revealed that the sentinel node was the only node involved in 22/46 (47.8%). The sentinel node was found to be negative in the remaining 107/153 lesions (69.9%), and surgical treatment was considered to be complete. To date, the mean follow-up of the patients has been 20.4 months (range 3-49), and no axillary recurrences have been observed. Of the entire group, four patients developed distant metastases; one had concomitant mammary recurrence and died. Conclusions Application of sentinel node biopsy is safe and has improved our results. This technique allows correct staging and probably maintains local control of the disease.Cirugía Española 12/2007; 82(6):352-357. · 0.89 Impact Factor