Abstract
Purpose
To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer.
Methods
In the period 2001–2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique (99mTc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located.
Results
Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43–44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla.
Conclusion
The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue.
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References
Motomura K, Egawa C, Komoike Y, Kataoka T, Nagumo S, Koyama H, et al. Sentinel node biopsy for breast cancer: technical aspects and controversies. Breast Cancer 2007;14:25–30.
Lyman GH, Giuliano AE, Somerfield MR, Benson AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23:7703–20.
McCready D, Holloway C, Shelley W, Down N, Robinson P, Sinclair S, et al. Surgical management of early stage invasive breast cancer: a practice guideline. Can J Surg 2005;48:185–94.
Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel lymph node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 2006;7:983–90.
Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;7:546–53.
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.
Estourgie SH, Valdes Olmos RA, Nieweg OE, Hoefnagel CA, Rutgers EJT, Kroon BBR. Excision biopsy of breast lesions changes the pattern of lymphatic drainage. Br J Surg. 2007;94(9):1088–91.
Zavagno G, Rubello D, Franchini Z, Meggiolaro F, Ballarin A, Casara D, et al. Axillary sentinel lymph nodes in breast cancer: a single lymphatic pathway drains the entire mammary gland. Eur J Surg Oncol 2005;3:479–84.
Benitez Segura A, Bajen Lazaro MT, Rodriguez-Gasen A, Guirao S, Ferran N, Ricart Y, et al. Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer. Rev Esp Med Nucl 2006;25:250–7.
Jansen JE, Bekker J, de Haas MJ, van der Weel FA, Verberne GH, Budel LM, et al. The influence of wire localisation for non-palpable breast lesions on visualisation of the sentinel node. Eur J Nucl Med Mol Imaging 2006;33:1296–300.
Strnad P, Rob L, Halaska MG, Chod J, Zuntova A, Moravcova Z. Radioguided occult lesion localisation in combination with detection of the sentinel lymph node in non-palpable breast cancer tumours. Eur J Gynaecol Oncol 2006;27:236–8.
Cortes M, Bajen MT, Gil M, Benito E, Moreno A, Guma A, et al. Simultaneous location of non-palpable breast neoplasms and sentinel node (SN) study by radioisotopic techniques. Rev Esp Med Nucl 2005;24:101–6.
Ronka R, Krogerus L, Leppanen E, von Smitten K, Leidenius M. Radio-guided occult lesion localization in patients undergoing breast-conserving surgery and sentinel node biopsy. Am J Surg 2004;187:491–6.
Kumar R, Jana S, Heiba SI, Dakhel M, Axelrod D, Siegel B, et al. Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable, or nonpalpable breast cancer. J Nucl Med 2003 Jan;44:7–10.
Barros A, Cardoso MA, Sheng PY, Costa PA, Pelizon C. Radioguided localization of non-palpable breast lesions and simultaneous sentinel lymph node mapping. Eur J Nucl Med Mol Imaging 2002;29:1561–5.
Tanis PJ, Nieweg OE, Valdes Olmos RA, Hoefnagel CA. An original approach in the diagnosis of early breast cancer: use of the same radiopharmaceutical for both non-palpable lesions and sentinel node localisation. Eur J Nucl Med Mol Imaging 2002;29:436–7.
Celebioglu F, Frisell J, Danielsson R, Bergkvist L. Sentinel node biopsy in non-palpable breast cancer and in patients with a previous diagnostic excision. Eur J Surg Oncol 2007;33:276–80.
Tafra L, Lannin DR, Swanson MS, Van Eyk JJ, Verbanac KM, Chua AN, et al. Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg 2001;233:51–9.
Varghese P, Mostafa A, Abdel-Rahman AT, Akberali S, Gattuso J, Canizales A, et al. Methylene blue dye versus combined dye-radioactive tracer technique for sentinel lymph node localisation in early breast cancer. Eur J Surg Oncol 2007;33:147–52.
Radovanovic Z, Golubovic A, Plzak A, Stojiljkovic B, Radovanovic D. Blue dye versus combined blue dye-radioactive tracer technique in detection of sentinel lymph node in breast cancer. Eur J Surg Oncol 2004;30:913–7.
Cserni G, Rajtar M, Boross G, Sinko M, Svebis M, Baltas B. Comparison of vital dye-guided lymphatic mapping and dye plus gamma probe-guided sentinel node biopsy in breast cancer. World J Surg 2002;26:592–7.
Cox CE. Lymphatic mapping in breast cancer: combination technique. Ann Surg Oncol 2001;8:67S–70S.
Cox CE, Salud C, Whitehead GF, Reintgen DS. Sentinel lymph node biopsy for breast cancer: combined dye-isotope technique. Breast Cancer 2000;7:389–97.
Villa G, Gipponi M, Buffoni F, Vecchio C, Bianchi P, Agnese G, et al. Localization of the sentinel lymph node in breast cancer by combined lymphoscintigraphy, blue dye and intraoperative gamma probe. Tumori 2000;86:297–9.
Canavese G, Gipponi M, Catturich A, Di Somma C, Vecchio C, Rosato F, et al. Sentinel lymph node mapping in early-stage breast cancer: technical issues and results with vital blue dye mapping and radioguided surgery. J Surg Oncol 2000;74:61–8.
Linehan DC, Hill AD, Akhurst T, Yeung H, Yeh SD, Tran KN, et al. Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol 1999;6:450–4.
Acknowledgements
We are grateful to the technical staff from nuclear medicine, general surgery and pathology departments of the Universitary Hospital of Salamanca, Spain. There are no declared conflicts of interest.
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Ruano, R., Ramos, M., Garcia-Talavera, J.R. et al. Staging the Axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer. Eur J Nucl Med Mol Imaging 35, 1299–1304 (2008). https://doi.org/10.1007/s00259-008-0730-4
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DOI: https://doi.org/10.1007/s00259-008-0730-4