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Optimized sentinel node scintigraphy in breast cancer

G Paganelli¹, C De Cicco, M Cremonesi

¹Division of Nuclear Medicine, Istituto Europeo di Oncologia, Milan, Italy.

The Quarterly Journal of Nuclear Medicine : Official Publication of the Italian Association of Nuclear Medicine (AIMN) [And] the International Association of Radiopharmacology (IAR)

|July 1, 1998

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Sentinel lymph node biopsy using lymphoscintigraphy accurately predicts axillary lymph node status in breast cancer patients. This technique can help avoid unnecessary axillary lymph node dissection, improving patient outcomes.

Area of Science:

Oncology
Nuclear Medicine
Surgical Pathology

Background:

Axillary lymph node dissection (ALND) is crucial for breast cancer staging but may be overused for small tumors with low metastasis rates.
A non-invasive method to predict axillary lymph node (ALN) status could prevent unnecessary ALND procedures.

Purpose of the Study:

To determine the optimal lymphoscintigraphy technique for sentinel node (SN) detection in breast cancer.
To evaluate if a disease-free SN reliably indicates a disease-free axilla.

Main Methods:

Lymphoscintigraphy was performed on 215 breast cancer patients prior to surgery.
Three radiotracer types (particle size < 50-1000 nm) were injected subdermally or peritumorally.
Sentinel nodes were identified using early/late imaging and biopsied with a gamma detection probe (GDP).

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Main Results:

The sentinel node (SN) was successfully identified in 97.6% of patients (210/215).
SN status accurately predicted ALN status in 97.1% (204/210) of cases.
In tumors < 1.5 cm, SN biopsy was 100% accurate; 37.7% of positive ALNs were solely in the SN.

Conclusions:

Lymphoscintigraphy is an effective method for SN localization in breast cancer.
Larger microcolloids and subdermal injection improved SN detection and are recommended.
Routine SN biopsy for patients without clinical axillary involvement can spare them complete ALND if the SN is disease-free.