Routine preoperative lymphoscintigraphy is not necessary prior to sentinelnode biopsy for breast cancer

BACKGROUND: This prospective study was performed to ascertain the added ben efit of lymphoscintigraphy to a standard method of intraoperative lymphatic mapping and sentinel node biopsy for breast cancer. METHODS: Patients with invasive breast cancer were injected with Tc-99m sul fur colloid prior to sentinel node biopsy; preoperative lymphoscintigraphy was then performed in half of the patient population. RESULTS: Sentinel node identification was possible in 45 of 50 patients (90 %). All 14 patients (31%) with axillary nodal metastases hard at least one histologically positive sentinel node (0% false negative rate), Lymphoscint igraphy revealed sentinel nodes in 17 of the 24 patients (70.8%) imaged. Al l 17 of these patients had one or more axillary sentinel nodes identified u sing intraoperative lymphatic mapping. In addition, 5 of 7 patients with a negative preoperative lymphoscintogram had an axillary sentinel lymph node( s) identified intraoperatively. None of the tumors showed drainage to the i nternal mammary lymph node chain by lymphoscintigraphy despite the fact tha t there were 5 patients with inner quadrant tumors. There was no significan t advantage with respect to sentinel lymph node localization (91.7% versus 88.5%, P = not significant) or false negative rate (0%, both groups, P = no t significant) in the group undergoing preoperative lymphoscintigraphy when compared with the patients in whom lymphoscintigraphy was not performed. CONCLUSIONS: Preoperative lymphoscintigraphy adds little additional informa tion to intraoperative lymphatic mapping, and its routine use is not justif ied. (C) 1999 by Excerpta Medica, Inc.