Gamma probe and ultrasonographically-guided fine-needle aspiration biopsy of sentinel lymph nodes in breast cancer patients

Aim: The purpose of the present study was to evaluate the usefulness of gam ma probe and ultrasonographically-guided fine-needle aspiration biopsy (FNA B) in the pre-operative detection of sentinel node (SN) metastasis in breas t cancer patients. Methods: Sentinel node biopsy (SNB) was performed in patients with stage I or II breast cancer with clinically negative nodes using dye and radio-isot ope. Axillas of 60 patients in whom a hot spot was detected by gamma probe were examined by ultrasonography. Pre-operative diagnosis of SN metastasis by gamma probe and ultrasonographically-guided FNAB was compared with the h istological results of SN. Results: The sensitivity, specificity and overall accuracy of ultrasonograp hy in the diagnosis of SN metastasis were 50.0%, 92.1% and 76.7%, respectiv ely. SNs were visualized by ultrasonography in 29 of 60 patients. Of 14 pat ients with positive results by ultrasonography, four had positive and two h ad negative cytology. The combination of ultrasonography and ultrasonograph ically-guided FNAB for visualized nodes had a sensitivity of 78.5%, specifi city of 93.3% and overall accuracy of 86.2%. Blind FNAB in the hot spot was not useful in the detection of SN metastasis in patients whose SNs failed to be detected by ultrasonography. Conclusions: Gamma probe and ultrasonographically-guided FNAB is a potentia lly useful method for pre-operative detection of SN metastasis. In patients with positive SNs, SNB is not indicated and complete axillary lymph-node d issection can be performed as a primary procedure. (C) 2001 Harcourt Publis hers Ltd.