Lymph scintigraphy and pre- and intraoperative gamma probe measurements for localization of sentinel lymph nodes (SLN) in breast cancer

Aim of this study was to prove the clinical value of nuclear medicine proce dures to detect the sentinel lymph node (SLN) for SLN biopsy. Methods: In 1 32 patients with breast cancer we performed lymph scintigraphy of the breas t as well as both pre- and intraoperative gamma probe measurements correlat ing the results with the findings of histopathology. Results: SLN were dete ctable in 62 of 110 patients according to a sensitivity of 56% when scannin g was performed only at 1-2 h p.i. while the sensitivity increased to 86% ( 19 of 22 pts.) if sequential images were acquired up to 2 h p.i. One or mor e SLN were identified by a handheld gamma probe transcutaneously prior to s urgery in 96% (113 of 118 pts.) of the patients who showed up with no clini cally suspected lymph node metastases. Intraoperatively, in additionally 2 patients the SLN could be found resulting in a sensitivity of 97% (115 of 1 18 pts.). in only 3 patients with clinically no tumor spread to axillary ly mph nodes no SIN could be identified by the probe. Skip lesions, i.e. lymph node metastases in patients with tumor-free SLN, occured in 2 cases. due t o SLN biopsy in these patients lymph node staging was false negative compar ed to conventional staging by means of axillary lymph node dissection. Conc lusion: The results demonstrate a high preoperative detection rate of SLN i n patients with breast cancer using lymph scintigraphy and gamma probe meas urements. Thus, nuclear medicine is capable of providing the basic requirem ents for SLN biopsy in the daily routine.