ORIGINAL ARTICLES  BREAST CANCER II 

The Quarterly Journal of Nuclear Medicine 1998 March;42(1):49-53

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Optimized sentinel node scintigraphy in breast cancer

Paganelli G., De Cicco C., Cremonesi M., Prisco G., Calza P., Luini A.*, Zucali P.*, Veronesi U.*

From the Division of Nuclear Medicine *Division of Senology Istituto Europeo di Oncologia, Milan, Italy

Introduction. Axillary ­lymph ­node dis­sec­tion (­ALND) rep­re­sents an impor­tant stag­ing pro­ce­dure in the sur­gi­cal treat­ment of ­breast can­cer. However, it may ­result nec­es­sary in ­tumors of lit­tle dimen­sions ­because of low per­cent­age of met­a­stat­ic axil­lary ­lymph ­node (ALN). If a non inva­sive tech­nique pre­dict­ed the stat­us of ALN, ­ALND pro­ce­dures ­could be ­avoided. We car­ried out ­this ­study i) to estab­lish the ­best tech­nique to per­form the lym­phos­cin­tig­ra­phy for detect­ing the sentinel node in ­breast can­cer and ii) to deter­mine wheth­er a ­clear sen­ti­nel ­node reli­ably pre­dicts a dis­ease ­free axil­la.
Methods. 215 ­patients ­were sub­mit­ted to the lym­phos­cin­tig­ra­phy ­before sur­gery. Three dif­fer­ent col­loid­al radio­trac­ers ­with par­ti­cle ­size rang­ing ­between <50 and 1000 nm ­were inject­ed suder­mi­cal­ly or per­i­tu­mo­ral­ly. Early and ­late imag­es ­were record­ed in ante­ri­or and ­oblique pro­jec­tions and the SN was ­marked on the ­skin and biop­sied ­using a gam­ma detec­tion ­probe (GDP) dur­ing sur­gery.
Results. The SN was iden­ti­fied in 210/215 cas­es (97.6%). The SN accu­rate­ly pre­dict­ed axil­lary ALN stat­us in 204/210 (97.1%) ­patients in ­whom a sen­ti­nel ­node was iden­ti­fied and in all the cas­es (45 ­patients) ­with ­tumor <1.5 cm in diam­e­ter. In 38/101 cas­es ­with met­a­stat­ic axil­lary ­nodes (37.7%) the ­only pos­i­tive ­node was the SN.
Conclusions. Lymphoscintigraphy can eas­i­ly ­locate the SN in ­breast can­cer. SN detec­tion result­ed easi­er ­when ­large ­size micro­col­loids ­were ­used. Subdermally admin­is­tra­tion ­appeared the ­best way of injec­tion for pal­pa­ble ­lesions. Breast can­cer ­patients with­out clin­i­cal involve­ment of the axil­la ­should under­go SN biop­sy rou­tine­ly and this may allow sparing com­plete axil­lary dis­sec­tion ­when the SN is ­free of dis­ease.