BREAST-CANCER, THE RETURN OF LYMPHOSCINTIGRAPHY

Lymphoscintigraphy, after arousing great hope in the past in the field of breast cancer has now been abandoned The inability of this examina tion to predict the metastatic status of the nodes, and progress in th erapeutic concepts have led to abandoning this technique. However, cer tain problems encountered by regional irradiation programmes and the w ork concerning sentinel node detection may bring this technique back i nto the spotlight. Lymphoscintigraphy may make it possible to adopt an individual approach, case by case, of the lymphatic drainage basins i n breast tumors, thus enabling certain patients to benefit from region al irradiation when it would not have been traditionally recommended f or this irradiation. Another aspect concerns the problem of the the vo lumes irradiated. Work carried our with lymphoscintigraphy has enabled internal mammary chain nodes to be precisely located Theses studies s how the necessity of adapting the irradiation field to each individual case, but the clinical impact is limited, in the end by the low recur rence rate in the internal mammary chain area. However the new techniq ues of computer merging of scintigraphic and scanner images could enab le the spatial position of the nodes in the upper axillary and supracl avicular regions to be determined. This would have, a priori, much wid er clinical impact Lymphoscintigraphic detection of the sentinel node is another field of major interest, but this technique is in competiti on with staining techniques. This procedure lends to a large reduction in morbidity of axillary surgery in 70% of patients. The use of techn iques for detecting micrometastases in the sentinel node opens prospec ts in terms of prognosis. The qualities of differents radiotracers and different injection sites possible are also discussed.