ULTRASONOGRAPHICALLY GUIDED INJECTION IMPROVES LOCALIZATION OF THE RADIOLABELED SENTINEL LYMPH-NODE IN BREAST-CANCER

Background: Several reports have demonstrated the accurate prediction of axillary nodal status (ANS) with radiolocalization and selective re section of sentinel lymph nodes (SLN) in breast cancer. To date, no te chnique has proven to be superior in localizing the SLN. Methods: 1.0 mCi of clear unfiltered (99m)technetium sulfur colloid was injected un der ultrasonographic (US) guidance around the perimeter of the breast lesion (palpable and nonpalpable) or previous biopsy site. Resection o f the radiolocalized nodes was performed, followed by complete axillar y lymph node dissection (AXLND). Results: Forty-two breast cancer pati ents underwent SLN biopsy after US-guided radiopharmaceutical injectio n. The SLN was localized in 41 patients (98%). The type of previously performed diagnostic biopsy did not influence the ability to localize the sentinel lymph node. Pathology revealed nodal metastasis in 7 of t he 41 evaluable patients (17%). ANS was accurately predicted in 40 of 41 patients (98%). Conclusions: Early experience with radiolocalizatio n and selective resection of SLN in breast cancer remains promising. U se of US-guided injection facilitates localization of the SLN, perhaps as a result of more accurate placement of the radionuclide marker. Us e of this technique allowed for effective management of patients regar dless of tumor size or the extent of prior biopsy, thereby expanding t he potential number of eligible patients for SLN biopsy.