Optimized sentinel node scintigraphy in breast cancer

Introduction Axillary lymph node dissection (ALND) represents an important staging procedure in the surgical treatment of breast cancer. However, it m ay result necessary on tumors of Little dimensions because of low percentag e of metastatic axillary lymph node (ALN). If a non invasive technique pred icted the status of ALN, ALND procedures could be avoided. We carried out t his study i) to establish the best technique to perform the lymphoscintigra phy for detecting the sentinel node in breast cancer and ii) to determine w hether a clear sentinel node reliably predicts a disease free axilla. Metho ds. 215 patients were submitted to the lymphoscintigraphy before surgery. T hree different colloidal radiotracers with particle size ranging between <5 0 and 1000 nm were injected sudermically or peritumorally. Early and late i mages were recorded in anterior and oblique projections and the SN was mark ed on the skin and biopsied using a gamma detection probe (GDP) during surg ery. Results. The SN was identified in 210/215 cases (97.6%). The SN accura tely predicted axillary ALN status in 204/210 (97.1%) patients in whom a se ntinel node was identified and in all the cases (45 patients) with tumor <1 .5 cm in diameter. In 38/101 cases with metastatic axillary nodes (37.7%) t he only positive node was the SN, Conclusions. Lymphoscintigraphy can easil y locate the SN in breast cancer. SN detection resulted easier when large s ize microcolloids were used. Subdermally administration appeared the best w ay of injection for palpable lesions. Breast cancer patients without clinic al involvement of the axilla should undergo SN biopsy routinely and this ma y allow sparing complete axillary dissection when the SN is free of disease .