Complementarity of Blue Dye and Isotope in Sentinel Node Localization for Breast Cancer: Univariate and Multivariate Analysis of 966 Procedures
- 330 Downloads
Background: The hypothesis that sentinel lymph node (SLN) mapping in breast cancer patients is optimized by combining blue dye and isotope is reasonable and intuitive. Despite this, few studies examine in detail the factors contributing to the success of these techniques, either individually or in combination.
Methods: During a time period of 21/2 years, 1000 consecutive patients at Memorial Sloan-Kettering Cancer Center had SLN mapping performed by using both blue dye and isotope, with preoperative lymphoscintigraphy (LSG). Among the 966 patients with invasive cancer, 12 variables were examined for their correlation with the success of SLN localization by blue dye, by isotope, and by the combined method, using univariate and multivariate models.
Results: By univariate analysis, blue dye success was more frequent in association with: a positive LSG (P = .02), age ≤60 (P < .0005), a previous surgical biopsy (P = .03), and an outer quadrant tumor (P < .0005). Isotope success was more frequent with a positive LSG (P < .0005), age ≤60 (P = .004), and intradermal isotope injection (P < .0005). Combined (dye and/or isotope) success was more frequent when there was a positive LSG (P < .0005), age ≤60 (P = .006) and intradermal isotope injection (P < .0005).
In multivariate analysis, blue dye success remained uniquely associated with outer quadrant tumor location (P < .0005), and isotope success was uniquely associated with intradermal isotope injection (P = .012). Combined success was more frequent with a positive LSG (P < .0005), age ≤60 (P = .033), and intradermal isotope injection (P = .003).
Conclusions: The five variables associated with successful SLN localization by blue dye or by isotope overlap but are not identical. Only three of these, intradermal isotope injection, a positive LSG, and age <60, predicted success by the dye-isotope combination in the multivariate model. Dye and isotope complement each other, and SLN biopsy for breast cancer should use both.
Key WordsLymphoscintigraphy Sentinel node biopsy Breast cancer surgery
Unable to display preview. Download preview PDF.
- 3.Pijpers R, Hoekstra OS, Collet GJ, et al. Impact of lymphoscintigraphy on sentinel node identification with technetium–99m–colloidal albumin in breast cancer. J Nucl Med 1997; 38: 366–8.Google Scholar
- 4.Roumen RMH, Valkenburg JGM, Geuskens LM. Lymphoscintigraphy and feasibility of sentinel node biopsy in 83 patients with primary breast cancer. Eur J Surg Oncol 1997; 23: 495–502.Google Scholar
- 5.Galimberti V, Zurrida S, Zucali P, Luini A. Can sentinel node biopsy avoid axillary dissection in clinically node–negative breast cancer patients? Breast J 1998; 7: 8–10.Google Scholar
- 7.Krag DN, Ashikaga T, Harlow SP, Weaver DL. Development of sentinel node targeting technique in breast cancer patients. Breast J 1998; 4: 67–74.Google Scholar
- 8.Offodile R, Hoh C, Barsky SH, et al. Minimally invasive breast Cancer staging using lymphatic mapping with radiolabeled dextran. Cancer 1998; 82: 1704–8.Google Scholar
- 9.Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer – a multicenter validation study. New Engl J Med 1998; 339: 941–6.Google Scholar
- 10.Crossin JA, Johnson AC, Stewart PB, Turner WW. Gamma–probe–guided resection of the sentinel lymph node in breast cancer. Am Surgeon 1998; 64: 666–9.Google Scholar
- 11.Rubio IT, Kogourian S, Cowan C, Krag DN, Colvert M, Klimberg S. Sentinel lymph node biopsy for staging breast cancer. Am J Surg 1998; 176: 532–7.Google Scholar
- 12.Snider H, Dowlatshahi K, Fan M, Bridger WM, Rayudu G, Oleske D. Sentinel node biopsy in the staging of breast cancer. Am J Surg 1998; 176: 305–10.Google Scholar
- 13.Winchester DJ, Sener SF, Winchester DP, et al. Sentinel lymphadenectomy for breast cancer: experience with 180 consecutive patients: efficacy of filtered technetium 99m sulphur colloid with overnight migration time. J Am Coll Surg 1999; 188: 597–603.Google Scholar
- 14.Feldman SM, Krag DN, McNally RK, Moor BB, Weaver DL, Klein P. Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy. J Am Coll Surg 1999; 188: 248–54.Google Scholar
- 15.Moffat FL, Gulec SA, Sittler SY, et al. Unfiltered sulfur colloid and sentinel node biopsy for breast cancer: technical and kinetic considerations. Ann Surg Oncol 1999; 6: 746–55.Google Scholar
- 17.Miner TJ, Shriver CD, Jaques DP, Maniscalco–Theberge ME, Krag DN. Sentinel lymph node biopsy for breast cancer: the role of previous biopsy on patient eligibility. Am Surg 1999; 65: 493–9.Google Scholar
- 19.Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15: 2345–50.Google Scholar
- 21.Flett MM, Going JJ, Stanton PD, Cooke TG. Sentinel node localization in patients with breast cancer. Br J Surg 1998; 85: 991–3.Google Scholar
- 22.Kern KA. Sentinel lymph node mapping in breast cancer using subareolar injection of blue dye. J Am Coll Surg 1999; 189: 539–45.Google Scholar
- 23.Morgan A, Howisey RL, Aldape HC, et al. Initial experience in a community hospital with sentinel lymph node mapping and biopsy for evaluation of axillary lymph node status in palpable invasive breast cancer. J Surg Oncol 1999; 72: 24–31.Google Scholar
- 24.Morrow M, Rademaker AW, Bethke KP, et al. Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 1999; 126: 714–22.Google Scholar
- 26.Borgstein PJ, Meijer S, Pijpers R. Intradermal blue dye to identify sentinel lymph node in breast cancer. Lancet 1997; 349: 1668–9.Google Scholar
- 27.O’Hea BJ, Hill ADK, El–Shirbiny A, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan–Kettering Cancer Center. J Am Coll Surg 1998; 186: 423–7.Google Scholar
- 28.Barnwell JM, Arredondo MA, Kollmorgen D, et al. Sentinel node biopsy in breast cancer. Ann Surg Oncol 1998; 5: 126–30.Google Scholar
- 29.Bass SS, Cox CE, Ku NN, Berman C, Reintgen DS. The role of sentinel lymph node biopsy in breast cancer. J Am Coll Surg 1999; 189: 183–94.Google Scholar
- 30.Burak WE, Walker MJ, Yee LD, et al. Routine preoperative lymphoscintigraphy is not necessary prior to sentinel node biopsy for breast cancer. Am J Surg 1999; 177: 445–9.Google Scholar
- 31.Nwariaku FE, Euhus DM, Beitsch PD, et al. Sentinel lymph node biopsy, an alternative to elective axillary dissection for breast cancer. Am J Surg 1998; 176: 529–31.Google Scholar
- 32.Jaderborg JM, Harrison PB, Kiser JL, Maynard SL. The feasibility and accuracy of sentinel lymph node biopsy for breast carcinoma. Am Surg 1999; 65: 699–705.Google Scholar
- 33.Hill ADK, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999; 229: 528–35.Google Scholar
- 34.Linehan DC, Hill ADK, Tran KN, et al. Sentinel lymph node biopsy in breast cancer: unfiltered radioisotope is superior to filtered. J Am Coll Surg 1999; 188: 377–81.Google Scholar
- 35.Linehan DC, Hill ADK, Akhurst T, Tran KN, Borgen PI, Cody HS. Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol 1999; 6: 450–4.Google Scholar
- 37.Haigh PI, Hansen NM, Qi K, Giuliano AE. Biopsy method and excision volume do not effet success rate of subsequent sentinel lymph node dissection in breast cancer. Ann Surg Oncol 2000; 7: 21–7.Google Scholar
- 38.Thompson JF, Uren RF, Shaw HM, et al. Location of sen-tinel lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy. J Am Coll Surg 1999; 189: 195–204.Google Scholar
- 39.Jansen L, Doting MH, Rutgers EJ, et al. Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer. Br J Surg 2000; 87: 920–25.Google Scholar
- 40.Boolbol SK, Fey J, Borgen PI, et al. Intradermal isotope injection: a highly accurate method of lymphatic mapping in breast carcinoma. SSO Cancer Symposium Abstracts 2000; 27: 75.Google Scholar