Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer

Identification of the sentinel node by using colloidal tracers and a gamma probe or lymphoscintigraphy could be an effective alternative for the complicated original dye-oriented approach. We studied the sentinel node detection rate using early and delayed imaging in breast cancer patients.

Thirty-seven patients were imaged 2 hr and 18 hr after peritumoral injection of 99mTc-colloidal albumin. Preoperatively, axillary foci were located with a handheld gamma probe that was also used to isolate radiolabeled nodes from the axillary dissection specimens. The predictive value of the sentinel node for the axillary tumorstatus was evaluated with histological examination.

Two and 18 hr after injection, lymphoscintigraphy revealed one to three separate axillary lymph nodes in 33 and 34 patients, respectively. In 30 patients the axillary foci were easily localized with the gamma probe preoperatively. In all 34 patients (92%), with visualized axillary foci, at least one radioactive sample could be retrieved using the gamma probe (total 53 samples). Metastases were found in the sentinel nodes of 11 patients, in seven of 11 being the only tumor-positive lymph node in the axilla. There were no false-negative sentinel nodes.

The selective targeting and prolonged intranodal retention of 99mTc-colloidal albumin allows successful sentinel node identification in most (92%) patients.