Skip to main content
SpringerLink
Log in

Results of Preoperative Lymphoscintigraphy for Breast Cancer Are Predictive of Identification of Axillary Sentinel Lymph Nodes

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The aim of this study was to identify the variables associated with successful peroperative sentinel lymph node (SLN) localization. We studied 201 patients with T1, T2, N0 invasive breast cancer who underwent a SLN procedure from 1999 to 2003. Of these 201 patients, 55 underwent peritumoral and 146 underwent periareolar radioisotope injection before the blue dye injection. All patients were operated on by breast conservative surgery and axillary dissection after SLN biopsy. Age, weight, menopausal status, previous biopsy, localization of the tumor, results of lymphoscintigraphy, site of radiotracer injection, tumor size, tumor grade, experience of surgeons, and the number of invaded axillary nodes were analyzed to determine whether they had any significant correlation with successful identification of SLN. Variables found to have a statistically significant influence on the SLN identification rate and on preoperative lymphoscintigraphy identification were introduced into a univariate and multivariate logistic regression model. In multivariate analysis, successful lymphoscintigraphy (P < 0.0001) and the absence of metastatic axillary nodes (P < 0.005) were associated with successful identification of SLNs. The peritumoral injection of radiotracer (P < 0.001), patient age > 60 years (P < 0.003), and localization of the tumor in the upper outer quadrant (P < 0.004) were associated with failure of lymphoscintigraphic visualization of SLN. The technique of SLN detection thus appears to be better for patients with low risk of invaded axillary lymph nodes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mauriac L, Luporsi E, Cutuli B, et al. Version of the standards, options and recommendations for non metastatic breast cancer (updated January 2001). Br J Cancer 2003;89:S17–S31

    Article  PubMed  Google Scholar 

  2. Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993;2:335–340

    Article  PubMed  CAS  Google Scholar 

  3. Edge SB, Niland JC, Bookman MA, et al. Emergence of sentinel node biopsy in breast cancer as standard-of-care in Academic Comprehensive Cancer Centers. J Natl. Cancer Inst 2003;95:1514–1521

    PubMed  Google Scholar 

  4. Borgstein PJ, Meijer S, Pijpers RJ, et al. Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg 2000;232:81–89

    Article  PubMed  CAS  Google Scholar 

  5. Kuehn T, Bembenek A, Decker T, et al. A concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance. Cancer 2005;103:451–461

    Article  PubMed  Google Scholar 

  6. Haigh PI, Hansen NM, Giuliano AE, et al. Factors affecting sentinel node localization during preoperative breast lymphoscintigraphy. J Nucl Med 2000;41:1682–1688

    PubMed  CAS  Google Scholar 

  7. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391–398; discussion 398–401

    PubMed  CAS  Google Scholar 

  8. Gulec SA, Moffat FL, Carroll RG, et al. Sentinel lymph node localization in early breast cancer. J Nucl Med 1998;39:1388–1393

    PubMed  CAS  Google Scholar 

  9. Tanis PJ, Nieweg OE, Valdes Olmos RA, et al. Anatomy and physiology of lymphatic drainage of the breast from the perspective of sentinel node biopsy. J Am Coll SurgS 2001;192:399–409

    CAS  Google Scholar 

  10. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer-a multicenter validation study. N Engl J Med 1998;339:941–946

    Article  PubMed  CAS  Google Scholar 

  11. Pelosi E, Baiocco C, Ala A, et al. Lymphatic mapping in early stage breast cancer: comparison between periareolar and subdermal injection. Nucl Med Commun 2003;24:519–523

    Article  PubMed  CAS  Google Scholar 

  12. McMasters KM, Wong SL, Martin RC 2nd, et al. Dermal injection of radioactive colloid is superior to peritumoral injection for breast cancer sentinel lymph node biopsy: results of a multiinstitutional study. Ann Surg 2001;233:676–687

    Article  PubMed  CAS  Google Scholar 

  13. Nieweg OE, Jansen L, Valdes Olmos RA, et al. Lymphatic mapping and sentinel lymph node biopsy in breast cancer. Eur J Nucl Med Mol Imaging 1999;26:S11–S16

    CAS  Google Scholar 

  14. Valdes-Olmos RA, Jansen L, Hoefnagel CA, et al. Evaluation of mammary lymphoscintigraphy by a single intratumoral injection for sentinel node identification. J Nucl Med 2000;41:1500–1506

    PubMed  CAS  Google Scholar 

  15. Bauer TW, Spitz FR, Callans LS, et al. Subareolar and peritumoral injection identify similar sentinel nodes for breast cancer. Ann Surg Oncol 2002;9:169–176

    Article  PubMed  Google Scholar 

  16. Cody HS 3rd, Fey J, Akhurst T, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures. Ann Surg Oncol 2001;8:13–19

    PubMed  Google Scholar 

  17. Chagpar A, Martin RC III, Chao C, et al. Validation of subareolar and periareolar injection techniques for breast sentinel lymph node biopsy. Arch Surg 2004;139:614–620

    PubMed  Google Scholar 

  18. Tuttle TM, Colbert M, Christensen R, et al. Subareolar injection of 99mTc facilitates sentinel lymph node identification. Ann Surg Oncol 2002;9:77–81

    Article  PubMed  Google Scholar 

  19. Linehan DC, Hill AD, Akhurst T, et al. Intradermal radiocolloid and intraparenchymal blue dye injection optimize sentinel node identification in breast cancer patients. Ann Surg Oncol 1999;6:450–454

    Article  PubMed  CAS  Google Scholar 

  20. Brenot-Rossi I, Houvenaeghel G, Jacquemier J, et al. Nonvisualization of axillary sentinel node during lymphoscintigraphy: is there a pathologic significance in breast cancer? J. Nucl Med 2003;44:1232–1237

    Google Scholar 

  21. Shimazu K, Tamaki Y, Taguchi T, et al. Comparison between periareolar and peritumoral injection of radiotracer for sentinel lymph node biopsy in patients with breast cancer. Surgery 2002;131:277–286

    Article  PubMed  Google Scholar 

  22. Sanidas EE, de Bree E, Tsiftsis DD. How many cases are enough for accreditation in sentinel lymph node biopsy in breast cancer? Am. J Surg 2003;185:202–210

    Article  PubMed  Google Scholar 

  23. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345–2350

    PubMed  CAS  Google Scholar 

  24. Sanidas EE, Daskalakis M, Sbyrakis N, et al. Modifications of the learning curve guidelines for breast cancer sentinel lymph node biopsy. Eur J Surg Oncol 2005;31:357–363

    Article  PubMed  CAS  Google Scholar 

  25. Tanis PJ, van Sandick JW, Nieweg OE, et al. The hidden sentinel node in breast cancer. Eur J Nucl Med Mol Imaging 2002;29:305–311

    PubMed  CAS  Google Scholar 

  26. Morrow M, Rademaker AW, Bethke KP, et al. Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 1999;126:714–720; discussion 720–722

    PubMed  CAS  Google Scholar 

  27. Ahrendt GM, Laud P, Tjoe J, et al. Does breast tumor location influence success of sentinel lymph node biopsy? J. Am Coll Surg 2002;194:278–284

    Article  PubMed  Google Scholar 

  28. Haigh PI, Hansen NM, Qi K, et al. Biopsy method and excision volume do not affect success rate of subsequent sentinel lymph node dissection in breast cancer. Ann Surg Oncol 2000;7:21–27

    Article  PubMed  CAS  Google Scholar 

  29. Maza S, Thomas A, Winzer KJ, et al. Subareolar injection of technetium-99m nanocolloid yields relaible data on the axillary lymph node tumour status in breast cancer patients with previous manipulations on the primary tumour: a prospective study of 117 patients. Eur J Nucl Med Mol Imaging 2004;31:671–675

    PubMed  Google Scholar 

  30. Birdwell RL, Smith KL, Betts BJ, et al. Breast cancer: variables affecting sentinel lymph node visualization at preoperative lymphoscintigraphy. Radiology 2001;220:47–53

    PubMed  CAS  Google Scholar 

  31. Shimazu K, Tamaki Y, Taguchi T, et al. Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer. Ann Surg 2003;237:390–398.

    Article  PubMed  Google Scholar 

  32. Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2282 patients with breast cancer. World J Surg 2001;25:767–772

    Article  PubMed  CAS  Google Scholar 

  33. Pelosi E, Ala A, Bello M, et al. Impact of axillary nodal metastases on lymphatic mapping and sentinel lymph node identification rate in patients with early stage breast cancer. Eur. J. Nucl. Med. Mol. Imaging 2005;DOI:10.1007/s00259–005-1797–1799

    Google Scholar 

  34. Leppänen E, Leidenius M, Krogerus L, et al. the effect of patient and tumour characteristics on visualization of sentinel lymph nodes after a single intratumoural injection of Tc 99m labelled human albumin colloid in breast cancer. Eur J Surg Oncol 2002;28:821–826

    PubMed  Google Scholar 

  35. Kern KA. Concordance and validation study of sentinel lymph node biopsy for breast cancer using subareolar injection of blue dye and technetium 99m sulfur colloid. J Am Coll Surg. 2002;195:467–475

    PubMed  Google Scholar 

  36. Klimberg VS, Rubio IT, Henry R, et al. Subareolar versus peritumoral injection for location of the sentinel lymph node. Ann Surg 1999;229:860–864; discussion 864–865

    Article  PubMed  CAS  Google Scholar 

  37. Maza S, Valencia R, Geworski L, et al. Peritumoural versus subareolar administration of technetium-99m nanocolloid for sentinel lymph node detection in breast cancer: preliminary results of a prospective intra-individual comparative study. Eur J Nucl Med Mol Imaging 2003;30:651–656

    PubMed  Google Scholar 

  38. Kern KA. Lymphoscintigraphic anatomy of sentinel lymphatic channels after subareolar injection of Technetium 99m sulfur colloid. J Am Coll Surg 2001;193:601–608

    PubMed  CAS  Google Scholar 

  39. Czerniecki BJ, Bedrosian I, Faries M, et al. Revolutionary impact of lymphoscintigraphy and intraoperative sentinel node mapping in the clinical practice of oncology. Semin Nucl Med 2001;31:158–164

    PubMed  CAS  Google Scholar 

  40. Goyal A, Newcombe RG, Mansel RE, et al. Role of routine preoperative lymphoscintigraphy in sentinel node biopsy for breast cancer. Eur J Cancer 2005;41:238–243

    Article  PubMed  Google Scholar 

  41. Uren RF, Howman-Giles RB, Thompson JF, et al. Mammary lymphoscintigraphy in breast cancer. J Nucl Med 1995;36:1775–1780

    PubMed  CAS  Google Scholar 

  42. Hill AD, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528–535

    Article  PubMed  CAS  Google Scholar 

  43. Van der Ent FW, Kengen RA, van der Pol HA, et al. Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 2001;234:79–84

    PubMed  Google Scholar 

  44. Newman LA. Lymphatic mapping and sentinel lymph node biopsy in breast cancer patients: a comprehensive review of variations in performance and technique. J Am Coll Surg 2004;199:804–816

    PubMed  Google Scholar 

  45. 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;231:724–731

    Article  PubMed  CAS  Google Scholar 

  46. 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;8:354–360

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Centre Alexis Vautrin, Regional Cancer Center, Av. de Bourgogne, Vandoeuvre-Lès-Nancy, 54511, France

    Frédéric Marchal MD, Philippe Rauch MD, Olivier Morel MD, Jean Luc Verhaeghe MD & François Guillemin MD, PhD

  2. Department of Nuclear Medicine, CHU, Brabois Hospital, Av. de Bourgogne, Vandoeuvre-Lès-Nancy, 54511, France

    Jean Claude Mayer MD & Pierre Olivier MD

  3. Department of Pathology, Centre Alexis Vautrin, Regional Cancer Center, Av. de Bourgogne, Vandoeuvre-Lès-Nancy, 54511, France

    Agnès Leroux MD

Authors
  1. Frédéric Marchal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe Rauch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olivier Morel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Claude Mayer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre Olivier MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Agnès Leroux MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean Luc Verhaeghe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. François Guillemin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frédéric Marchal MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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. 30, 55–62 (2006). https://doi.org/10.1007/s00268-005-0145-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0145-3

Keywords

Search

Navigation