Non-visualization of sentinel lymph node in patients with breast cancer

Histological evaluation of the first draining lymph node (sentinel node) in the axilla of patients with breast cancer has dramatically altered the sur gical approach to these patients, with sparing of the axilla if no tumour c ells are identified. In a fraction of patients imaged after peri-tumoural i njection of the breast, there is no visualization of the sentinel node. We retrospectively analysed the status of patients whose nodes were visualized and of patients whose nodes failed to visualize, to define the variables a ssociated with non-visualization of the sentinel node. Seventy-four breast cancer patients were imaged following peritumoural injection of filtered Tc -99(m)-sulfur colloid, immediately and up to 5.5 h post-injection. The scin tigraphic data were analysed with reference to the patient's age, histology , grade, site and size of tumour, previous diagnostic procedure and time in terval to scan, using univariate analysis and a logistic regression model. A sentinel node was visualized in 53 of 74 women (72%). Comparison of patie nts with non-visualized versus visualized sentinel nodes disclosed no stati stically significant univariate relation to age of the patients (P = 0.10), size of tumour (P = 0.46), site (P = 0.26), histology [invasive ductal car cinoma in 16 of 20 (80%) non-visualized cases, and in 43 of 53 (81%) visual ized patients], prior excision biopsy (P=0.36) and time interval to surgery (P=0.29). Tumour grade was the only significant variable on univariate ana lysis (P=0.03), though multivariate analysis showed that none of the indepe ndent parameters were statistically significant. In 39 patients with an upp er outer quadrant tumour, the location of the sentinel node was not limited to the axilla and even crossed the midline of the breast. Our results show that none of the independent variables is associated with non-visualizatio n of sentinel lymph node on preoperative lymphoscintigraphy of patients wit h breast cancer, though the tumour grade may have contributed to non-visual ization of this node. The non-axillary drainage from upper outer quadrant t umours suggests the routine use of lymphoscintigraphy prior to axillary dis section. ((C) 2001 Lippincott Williams & Wilkins).