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Impact of axillary nodal metastases on lymphatic mapping and sentinel lymph node identification rate in patients with early stage breast cancer

  • Ettore Pelosi
  • Ada Ala
  • Marilena Bellò
  • Anastasios Douroukas
  • Giuseppe Migliaretti
  • Ester Berardengo
  • Teresio Varetto
  • Riccardo Bussone
  • Gianni BisiEmail author
Original Article

Abstract

Purpose

The aim of this study was to define the impact of the presence of axillary nodal metastases on lymphatic mapping and sentinel lymph node (SLN) identification rate in patients with early breast cancer.

Methods

Two hundred and forty-six lymphatic mapping procedures were performed with both labelled nanocolloid and blue dye, followed by SLN biopsy and/or complete axillary dissection. The following parameters were recorded: patient’s age, tumour laterality and location, tumour size, tumour histology, tumour stage, tumour grade, lymphovascular invasion, radiotracer injection site (subdermal–peritumoural/peri-areolar), SLN visualisation at lymphoscintigraphy, SLN metastases (presence/absence, size) and other axillary metastases (presence/absence, number). Discriminant analysis was used to analyse the data.

Results

SLNs were identified by labelled nanocolloid alone in 94.7% of tumours, by blue dye alone in 93.5% and by the combined technique in 99.2%. Discriminant analysis showed the gamma probe SLN identification rate to be significantly limited by the presence of axillary nodal metastases. In particular, the size of SLN metastases and the number of other axillary metastases were the most important variables in reducing the gamma probe SLN identification rate (p=0.004 and p=0.002, respectively). On the other hand, high tumour grade was the only parameter limiting the blue dye SLN identification rate.

Conclusion

The accuracy of lymphatic mapping with labelled nanocolloid is limited by the presence of axillary nodal metastases, and particularly by the degree of SLN tumoural invasion and the presence and number of other axillary nodal metastases. Neither of these elements seems to interfere with the blue dye identification rate. The combination of the two tracers maximises the SLN identification rate.

Keywords

Lymphatic mapping Axillary metastases Breast cancer Sentinel lymph node Accuracy 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ettore Pelosi
    • 1
    • 2
  • Ada Ala
    • 3
  • Marilena Bellò
    • 1
  • Anastasios Douroukas
    • 1
  • Giuseppe Migliaretti
    • 4
  • Ester Berardengo
    • 5
  • Teresio Varetto
    • 1
  • Riccardo Bussone
    • 3
  • Gianni Bisi
    • 1
    • 6
    Email author
  1. 1.S.C.D.U. Medicina Nucleare 2Ospedale S. Giovanni BattistaTurinItaly
  2. 2.Dottorato di Ricerca Radioimmunolocalizzazione dei Tumori UmaniUniversità TorinoTurinItaly
  3. 3.Reparto di Chirurgia Oncologica 10Ospedale S. Giovanni BattistaTurinItaly
  4. 4.Dipartimento di Sanità Pubblica e MicrobiologiaUniversità di TorinoTurinItaly
  5. 5.Servizio di Anatomia Patologica 4Ospedale S. Giovanni BattistaTurinItaly
  6. 6.Dipartimento di Medicina Interna, SCDU Medicina Nucleare 2Università di TorinoTurinItaly

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