Lymphatic mapping with intralesional tracer administration in breast carcinoma patients

BACKGROUND. The objectives of the study were to determine how often a senti nel lymph node is visualized by lymphoscintigraphy in breast carcinoma pati ents, how often the sentinel lymph node is identified during surgery, and t he sensitivity of these procedures to identify the presence of axillary lym ph node metastasis. METHODS. A total of 136 patients were enrolled in 2 hospitals. Preoperative dynamic and static lymphoscintigraphy were performed; in addition, both a vital dye and a gamma detection probe were used intraoperatively. The trace rs were injected into the primary lesion. Sentinel lymph node biopsy was fo llowed by completion axillary lymph node dissection. The sentinel lymph nod es and other axillary lymph nodes were examined routinely and by immunohist ochemical staining. RESULTS. A sentinel lymph node was visualized by lymphoscintigraphy in 118 patients (87%). During the operation a sentinel lymph node was localized in 126 patients (93%). A total of 224 sentinel lymph nodes were harvested (av erage of 1.7 and range of 1-4 sentinel lymph nodes per patient). Of all the sentinel lymph nodes, 37 were blue (17%), 68 were radioactive (30%), and 1 19 were both blue and radioactive (53%). The sentinel lymph nodes contained metastatic disease in 56 patients (44%). Three sentinel lymph node biopsie s were false-negative (sensitivity 95%). CONCLUSIONS, Sentinel lymph node biopsy with preoperative lymphoscintigraph y after intralesional tracer administration and intraoperative use of both a gamma detection probe and a vital dye is a reliable technique for staging the axilla of breast carcinoma patients. (C) 2000 American Cancer Society.