Clinical Significance of the Lymphoscintigraphy in the Evaluation of Non-axillary Sentinel Lymph Node Localization in Breast CancerM. Gherghe, C. Bordea, Al. Blidaru
Original article, no. 1, 2015
Background: Identification and biopsy of the sentinel lymphnode (SLN) in early-stage breast cancer (T1-T2N0) has becomethe standard method in the surgical treatment of the axilla, dueto its accuracy in the evaluation of axillary lymph node status,thus avoiding extensive axillary lymph node dissection inpatients with negative SLN. The aim of our study is to highlightthe role of 99mTc-nanocolloid lymphoscintigraphy in the preoperative lymphatic mapping, especially for SLN localizationsoutside the axilla, as well as the benefits of this techniquein the accurate staging of breast cancer.Materials and Method: 430 patients (age 31-81 years) with breastcancer (T1-T2N0 stage) were included in the study group, whounderwent lymphoscintigraphy in order to identify thesentinel lymph node in the Nuclear Medicine Department ofÃ¢Â€ÂœProf. Dr. Al. TrestioreanuÃ¢Â€Â Institute of Oncology, Bucharest,between October 2008 - July 2014. Radiocolloid (99mTcnanocolloid)was injected using peritumoral or periareolarintradermal technique, doses between 20-37 MBq (0.3-0.5 mlvolume), followed by static and dynamic post-injection acquisitions.Intraoperative identification of the SLN was performedusing a gamma-probe, guided by the skin marker performedpreoperatively after completion of lymphoscintigraphy.Results: 697 sentinel lymph nodes were identified throughimaging techniques in 427 patients (99%). Of them, 364patients had axillary localization of the SLN, while 48 patients(11%) had non-axillary (pectoral, internal mammary, supraclavicular,intra-mammary) localization and 15 patients (3%)had multiple localization (axillary and non-axillary).Intraoperative histopathological exam revealed lymphaticinvasion in 74 SLN (12% macrometastases and 88% micrometastases).Conclusions: The identification and biopsy of the sentinellymph node in stages I and IIA is a useful routine for accuratebreast cancer staging, suited for axillary lymphatic drainage, aswell as for unusual non-axillary SLN localization, guiding theclinician for further postoperative management of thesepatients.