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Preoperative Lymphoscintigraphy Predicts the Successful Identification but Is Not Necessary in Sentinel Lymph Nodes Biopsy in Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although preoperative lymphoscintigraphy in sentinel lymph node biopsy (SLNB) for breast cancer patients is undergone commonly, its clinical significance remains controversial.

Methods

We retrospectively analyzed our database that contained 636 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB.

Results

The sentinel lymph nodes (SLNs) of 86.5% of patients were well imaged by lymphoscintigraphy, and SLN were located extra-axilla in 5.3% patients. The visualization of SLN in lymphoscintigraphy was not associated with histopathologic type, location, and stage of primary tumor, as well as the time interval from injection of radiocolloid to surgery. The negative lymphoscintigraphy results were associated with excision `biopsy before injection of radiocolloid and positive axillary node statues. The SLN was successfully detected in 625 (98.3%) enrolled patients. Failure of surgical identification of axillary SLN was associated with whether hot spot was imaged by lymphoscintigraphy. However, we identified axillary SLN in 90 (90.9%) out of 99 patients with negative axillary findings in lymphoscintigram. The false negative rate of SLNB in our study was 16.0% (15 of 94) among patients of training group, and there was no significant difference in the false negative rate between patients who had axillary hot spot in lymphoscintigram and those who had not (P = .273).

Conclusions

Visualization of SLN in preoperative lymphoscintigraphy predicted the successful SLN identification. However, it was less informative for the location of SLN during operation. Considering the complexity, time consumed, and cost, lymphoscintigraphy should at present be undergone for investigation purposes only.

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REFERENCES

  1. Hilsenbeck SG, Ravdin PM, de Moor CA, Chamness GC, Osborne CK, Clark GM. Time-dependence of hazard ratios for prognostic factors in primary breast cancer. Breast Cancer Res Treat 1998; 52:227–37

    Article  PubMed  CAS  Google Scholar 

  2. Wang Y, Yu J, Wang L, Liu J, Yang G, Liu Y. The study of sentinel node biopsy in clinical node negative breast cancer in China.. Breast Cancer Res Treat 2004; 88:S89

    Article  Google Scholar 

  3. Cody HS, 3rd. Sentinel lymph node mapping in breast cancer. Oncology (Williston Park) 1999; 13:25–34; discussion 35–6, 39, 43

    Google Scholar 

  4. Cox CE, Haddad F, Bass S, et al. Lymphatic mapping in the treatment of breast cancer. Oncology (Williston Park) 1998; 12:1283–92; discussion 1293–4, 1297–8

    CAS  Google Scholar 

  5. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998; 339:941–6

    Article  PubMed  CAS  Google Scholar 

  6. McMasters KM, Giuliano AE, Ross MI, et al. Sentinel-lymph-node biopsy for breast cancer—not yet the standard of care. N Engl J Med 1998; 339:990–5

    Article  PubMed  CAS  Google Scholar 

  7. Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91:368–73

    Article  PubMed  CAS  Google Scholar 

  8. Mudun A, Murray DR, Herda SC, et al. Early stage melanoma: lymphoscintigraphy, reproducibility of sentinel node detection, and effectiveness of the intraoperative gamma probe. Radiology 1996; 199:171–5

    PubMed  CAS  Google Scholar 

  9. Thompson JF, Uren RF, Shaw HM, McCarthy WH, Quinn MJ, O’Brien CJ, Howman-Giles RB. Location of sentinel lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy. J Am Coll Surg 1999; 189:195–204

    Article  PubMed  CAS  Google Scholar 

  10. Teal CB, Slocum JP, Akin EA, Kelly TA. Correlation of lymphoscintigraphy with the number of sentinel lymph nodes identified intraoperatively in patients with breast cancer. Am J Surg 2005; 190:567–9

    Article  PubMed  Google Scholar 

  11. Shoher A, Diwan A, Teh BS, Lu HH, Fisher R, Lucci A Jr. Lymphoscintigraphy does not enhance sentinel node identification or alter management of patients with early breast cancer. Curr Surg 2006; 63:207–12

    Article  PubMed  Google Scholar 

  12. McMasters KM, Wong SL, Tuttle TM, et al. Preoperative lymphoscintigraphy for breast cancer does not improve the ability to identify axillary sentinel lymph nodes. Ann Surg 2000; 231:724–31

    Article  PubMed  CAS  Google Scholar 

  13. Marchal F, Rauch P, Morel O, et al. Results of preoperative lymphoscintigraphy for breast cancer are predictive of identification of axillary sentinel lymph nodes. World J Surg 2006; 30:55–62

    Article  PubMed  Google Scholar 

  14. Krynyckyi BR, Kim SC, Kim CK. Preoperative lymphoscintigraphy and triangulated patient body marking are important parts of the sentinel node process in breast cancer. World J Surg Oncol 2005; 3:56

    Article  PubMed  Google Scholar 

  15. Kim SC, Kim DW, Moadel RM, et al. Using the intraoperative hand held probe without lymphoscintigraphy or using only dye correlates with higher sensory morbidity following sentinel lymph node biopsy in breast cancer: a review of the literature. World J Surg Oncol 2005; 3:64

    Article  PubMed  Google Scholar 

  16. Goyal A, Newcombe RG, Mansel RE, et al. Role of routine preoperative lymphoscintigraphy in sentinel node biopsy for breast cancer. Eur J Cancer 2005; 41:238–43

    Article  PubMed  Google Scholar 

  17. Blessing WD, Stolier AJ, Teng SC, Bolton JS, Fuhrman GM. A comparison of methylene blue and lymphazurin in breast cancer sentinel node mapping. Am J Surg 2002; 184:341–5

    Article  PubMed  Google Scholar 

  18. Tuttle TM, Zogakis TG, Dunst CM, Zera RT, Singletary SE. A review of technical aspects of sentinel lymph node identification for breast cancer. J Am Coll Surg 2002; 195:261–8

    Article  PubMed  Google Scholar 

  19. Alazraki NP, Eshima D, Eshima LA, Herda SC, Murray DR, Vansant JP, Taylor AT. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers. Semin Nucl Med 1997; 27:55–67

    Article  PubMed  CAS  Google Scholar 

  20. De Cicco C, Cremonesi M, Luini A, et al. Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 1998; 39:2080–4

    PubMed  Google Scholar 

  21. Burak WE, Jr., 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

    Article  PubMed  Google Scholar 

  22. Upponi SS, McIntosh SA, Wishart GC, Balan KK, Purushotham AD. Sentinel lymph node biopsy in breast cancer—is lymphoscintigraphy really necessary? Eur J Surg Oncol 2002; 28:479–80

    PubMed  CAS  Google Scholar 

  23. Lawson LL, Sandler M, Martin W, Beauchamp RD, Kelley MC. Preoperative lymphoscintigraphy and internal mammary sentinel lymph node biopsy do not enhance the accuracy of lymphatic mapping for breast cancer. Am Surg 2004; 70:1050–5; discussion 1055–6

    PubMed  Google Scholar 

  24. Chagpar AB, Kehdy F, Scoggins CR, et al. Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer. Am J Surg 2005; 190:557–62

    Article  PubMed  Google Scholar 

  25. Kawase K, Gayed IW, Hunt KK, et al. Use of lymphoscintigraphy defines lymphatic drainage patterns before sentinel lymph node biopsy for breast cancer. J Am Coll Surg 2006; 203:64–72

    Article  PubMed  Google Scholar 

  26. Rousseau C, Classe JM, Campion L, et al. The impact of nonvisualization of sentinel nodes on lymphoscintigraphy in breast cancer. Ann Surg Oncol 2005; 12:533–8

    Article  PubMed  CAS  Google Scholar 

  27. Dupont EL, Kamath VJ, Ramnath EM, et al. The role of lymphoscintigraphy in the management of the patient with breast cancer. Ann Surg Oncol 2001; 8:354–60

    Article  PubMed  CAS  Google Scholar 

  28. Martin RC, 2nd, Chagpar A, Scoggins CR, Edwards MJ, Hagendoorn L, Stromberg AJ, McMasters KM. Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg 2005; 241:1005–12; discussion 1012–5

    Article  PubMed  Google Scholar 

  29. Degnim AC, Oh K, Cimmino VM, Diehl KM, Chang AE, Newman LA, Sabel MS. Is blue dye indicated for sentinel lymph node biopsy in breast cancer patients with a positive lymphoscintigram? Ann Surg Oncol 2005; 12:712–7

    Article  PubMed  Google Scholar 

  30. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006; 106:4–16

    Article  PubMed  Google Scholar 

  31. Carcoforo P, Sortini D, Feggi L, et al. Clinical and Therapeutic Importance of Sentinel Node Biopsy of the Internal Mammary Chain in Patients with Breast Cancer: A Single-Center Study with Long-Term Follow-Up. Ann Surg Oncol 2006; 13:1338–43

    Article  PubMed  Google Scholar 

  32. Hong J, Chog E, Soni N, Carmalt H, Gillett D, Spillane AJ. Extra-axillary sentinel node biopsy in the management of early breast cancer. Eur J Surg Oncol 2005; 31:942–8

    Article  PubMed  CAS  Google Scholar 

  33. Farrus B, Vidal-Sicart S, Velasco M, et al. Incidence of internal mammary node metastases after a sentinel lymph node technique in breast cancer and its implication in the radiotherapy plan. Int J Radiat Oncol Biol Phys 2004; 60:715–21

    Article  PubMed  Google Scholar 

  34. Allen B, Campbell I, Desai S, Dray M, Scarlet J. Pilot study comparing the accuracy of lymphoscintigraphy sentinel lymph node localisation with axillary node dissection in women with operable breast cancer. N Z Med J 2001; 114:233–6

    PubMed  CAS  Google Scholar 

  35. Klauber-DeMore N, Bevilacqua JL, Van Zee KJ, Borgen P, Cody HS 3rd. Comprehensive review of the management of internal mammary lymph node metastases in breast cancer. J Am Coll Surg 2001; 193:547–55

    Article  PubMed  CAS  Google Scholar 

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ACKNOWLEDGMENT

This work was partly supported by a grant from project of Department of Science and Technology of Shandong Province (003130139). We owe a great deal to all the patients enrolled in the studies for their support. Special thanks goes to Professor Min Li for his kindly help and sensible advice in the study and for his critical and thorough reading of this manuscript.

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Authors and Affiliations

  1. Breast Cancer Center, Shandong Cancer Hospital, Shandong Academy of Medical Science, 440 Jiyan Rd, Jinan, Shandong, P.R. China

    Lei Wang MD, Jin-ming Yu MD, Yong-sheng Wang MD, Wen-shu Zuo, Ji-yu Li, Zheng-bo Zhou, Yan-song Liu, Yong-qing Li, Yan-bing Liu, Tong Zhao & Peng Chen

  2. Department of Pathology, Shandong Cancer Hospital, Shandong Academy of Medical Science, 440 Jiyan Rd, Jinan, Shandong, P.R. China

    Yan Gao

  3. Department of Surgical Oncology, Shanghai Pulmonary Hospital, 507 Zheng Ming Rd, Shanghai, P.R. China

    Jiang Fan MD

  4. Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong Academy of Medical Science, 440 Jiyan Rd, Jinan, Shandong, P.R. China

    Xu-dong Hu, Ming-lu Chen & Guo-ren Yang MD

  5. School of Medicine, Shandong University, Jinan, Shandong, P.R. China

    Yong-sheng Wang MD

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  1. Lei Wang MD
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Correspondence to Yong-sheng Wang MD.

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Wang, L., Yu, Jm., Wang, Ys. et al. Preoperative Lymphoscintigraphy Predicts the Successful Identification but Is Not Necessary in Sentinel Lymph Nodes Biopsy in Breast Cancer. Ann Surg Oncol 14, 2215–2220 (2007). https://doi.org/10.1245/s10434-007-9418-4

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  • DOI: https://doi.org/10.1245/s10434-007-9418-4

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