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Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Identification of the sentinel lymph node (SLN) for small mammary tumours (cT1N0) sometimes leads to detection of internal mammary chain (IMC) drainage. This information is often ignored by physicians. The present study sought to determine the frequency with which an internal mammary SLN was identified by peritumoral injection of radioactive tracer, and then to determine the patients in whom identification of an internal mammary SLN could have an impact on the radiation treatment plan.

Materials

Between March 2002 and March 2008, 622 SLN biopsies performed in a cohort of 608 patients were analysed. Technetium-labelled nanocolloids were administered via three peritumoral injections, completed by a deep prepectoral injection, with the entire procedure performed under echographic guidance.

Results

The SLN was identified in 607 of the 622 patients, including 174 (28.7%) in the IMC. A total of 161 successful internal mammary biopsies were performed. Of the 622 patients, 18 showed SLN involvement in the IMC. In 7 of these patients, only the internal mammary SLN was affected. Prophylactic irradiation of the IMC was indicated in 376 patients, but only in 18 (4.8%) of these patients was there effectively IMC involvement; internal mammary SLN biopsy failed in 7 patients (1.9%).

Conclusion

SLN detection by peritumoral injection, combined with the systematic removal of the internal mammary SLN, enabled the involvement of this region to be found in a nonnegligible number of patients. Such information should make it possible to personalize treatment for patients with stage cT1 mammary cancer and thereby avoid needless internal mammary radiation therapy in a large number of patients (93.4% in our study).

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Acknowledgments

This study was carried out in the Department of Nuclear Medicine at the University Hospital, Grenoble (CHU) (Professor Fagret). The author would like to thank Pierre-Yves Brard, MD (Chambery Hospital) for his preliminary work.

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Authors and Affiliations

  1. Nuclear Medicine Department, Grenoble University Hospital, La Tronche, France

    Jean-Cyril Bourre, Céline Gallazzini-Crepin, Alex Calizzano, Marie-Dominique Desruet, Daniel Fagret & Jean-Philippe Vuillez

  2. Gynecology Department, Belledonne Healthcare Center, Saint-Martin d’Hères, France

    Raoul Payan

  3. Radiology Department, Grenoble University Hospital, La Tronche, France

    Delphine Collomb

  4. Pathology Department, Grenoble University Hospital, La Tronche, France

    Dominique Pasquier

  5. Department of Radiation Oncology, Grenoble University Hospital, La Tronche, France

    Michel Bolla

  6. INSERM U 877 Bioclinics Radiopharmaceuticals, University of Grenoble, La Tronche, France

    Daniel Fagret & Jean-Philippe Vuillez

  7. Service de médecine nucléaire, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 9, France

    Jean-Cyril Bourre

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  1. Jean-Cyril Bourre
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Correspondence to Jean-Cyril Bourre.

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Bourre, JC., Payan, R., Collomb, D. et al. Can the sentinel lymph node technique affect decisions to offer internal mammary chain irradiation?. Eur J Nucl Med Mol Imaging 36, 758–764 (2009). https://doi.org/10.1007/s00259-008-1034-4

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  • DOI: https://doi.org/10.1007/s00259-008-1034-4

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