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The Impact of Nonvisualization of Sentinel Nodes on Lymphoscintigraphy in Breast Cancer

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Abstract

Background

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.

Methods

Two hundred eighty patients with infiltrating breast carcinoma (T0, T1/T2) underwent preoperative lymphoscintigraphy before gamma probe–guided SN biopsy.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Service of Nuclear Medicine, René Gauducheau Cancer Center Nantes-Saint Herblain, Boulevard Monod, 44805, Saint Herblain Cedex, France

    C. Rousseau MD, C. Curtet PhD, B. Bridji MD & I. Resche MD

  2. Service of Surgery, René Gauducheau Cancer Center Nantes-Saint Herblain, Boulevard Monod, 44805, Saint Herblain Cedex, France

    J. M. Classe MD, F. Dravet MD & R. Pioud MD

  3. Service of Statistics, René Gauducheau Cancer Center Nantes-Saint Herblain, Boulevard Monod, 44805, Saint Herblain Cedex, France

    L. Campion MD

  4. Service of Pathology, René Gauducheau Cancer Center Nantes-Saint Herblain, Boulevard Monod, 44805, Saint Herblain Cedex, France

    C. Sagan MD

Authors
  1. C. Rousseau MD
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  2. J. M. Classe MD
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  3. L. Campion MD
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  4. C. Curtet PhD
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  5. F. Dravet MD
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  6. R. Pioud MD
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  7. C. Sagan MD
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  8. B. Bridji MD
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  9. I. Resche MD
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Corresponding author

Correspondence to C. Rousseau MD.

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Rousseau, C., Classe, J.M., Campion, L. et al. The Impact of Nonvisualization of Sentinel Nodes on Lymphoscintigraphy in Breast Cancer. Ann Surg Oncol 12, 533–538 (2005). https://doi.org/10.1245/ASO.2005.07.014

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  • DOI: https://doi.org/10.1245/ASO.2005.07.014

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