Predicting nodal metastases in breast cancer by lymphoscintigraphy

In a prospective trial, 89 women with breast lumps underwent bilateral axillary and internal mammary lymphoscintigraphy preoperatively, using technetium-99m antimony sulfide colloid. All scans were interpreted blindly by three separate observers. Breast biopsy was then performed; if the biopsy specimen showed malignant tumour, definitive therapy was performed with axillary dissection. The interpretation of the axillary and internal mammary lymphoscintigrams was subsequently compared with the histologic assessment of the axillary nodes. Of the 89 women, 54 had benign disease and 35 had cancer. The internal mammary lymphoscintigram was considered to show abnormality in only 1 of the 54 patients with benign disease. One patient with cancer was eliminated from the review. Sixteen of the remaining 34 patients had axillary node metastases. Of these, 8 had an abnormal internal mammary lymphoscintigram. Only 2 of the 18 patients with cancer but no axillary metastases had an abnormal internal mammary lymphoscintigram. One bilateral axillary lymphoscintigram in the 54 patients with benign disease was discarded for technical reasons. The axillary lymphoscintigram was accurate in 52 of the remaining 53 patients. Two such scintigrams in the 35 patients with breast cancer were discarded for technical reasons. The axillary lymphoscintigram indicated abnormalities in 12 of 16 patients with axillary nodal metastases but appeared normal in 13 of 17 patients without axillary metastases. Lymphoscintigraphy may play a valuable role in the staging of breast cancer in the future.