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Chahid Y, Verberne HJ, Poel E, Hendrikse NH, Booij J. Anatomical breast imaging-derived parameters do not provide incremental information in prediction of nonvisualization of sentinel lymph nodes on lymphoscintigraphy. Nucl Med Commun 2022; 43:877-880. [PMID: 35582847 PMCID: PMC9278706 DOI: 10.1097/mnm.0000000000001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Accurate sentinel lymph node (SLN) staging is essential for both prognosis and treatment in patients with breast cancer. However, the preoperative lymphoscintigraphy may fail to visualize the SLN. The aim of this retrospective study was to investigate whether parameters derived from anatomical breast imaging can predict SLN nonvisualization on lymphoscintigraphy. METHODS For this retrospective study, all data of mammography, breast MRI, and lymphoscintigraphy of SLN procedures from January 2016 to April 2021 were collected and reviewed from the Amsterdam UMC database. RESULTS A total of 758 breast cancer patients were included in this study. SLN nonvisualization on planar lymphoscintigraphy at 2-h postinjection (pi) was 29.7% and was reduced after a second injection to 7.5% at late lymphoscintigraphy 4-h pi. Multivariable analysis showed that age ≥ 70 years ( P = 0.019; OR, 1.82; 95% CI, 1.10-3.01), BMI ≥ 30 kg/m 2 ( P = 0.031; OR, 1.59; 95% CI, 1.04-2.43), and nonpalpable tumors ( P = 0.034; OR, 1.54; 95% CI, 1.03-2.04) were independent predictors of SLN nonvisualization. Differences in tumor size, Breast Imaging-Reporting and Data System classification, or breast density were not significantly associated with SLN nonvisualization. CONCLUSION This study shows that, by using a multivariable analysis, risk factors for SLN nonvisualization in breast cancer patients during preoperative lymphoscintigraphy at 2-h pi are age ≥ 70 years, BMI ≥ 30 kg/m 2 , and nonpalpable tumors. Parameters derived from mammography or breast MRI, however, are not useful to predict SLN nonvisualization on lymphoscintigraphy.
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Affiliation(s)
- Youssef Chahid
- Departments of Radiology and Nuclear Medicine
- Clinical Pharmacy, Amsterdam UMC, location AMC
| | | | - Edwin Poel
- Departments of Radiology and Nuclear Medicine
| | - N. Harry Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Jan Booij
- Departments of Radiology and Nuclear Medicine
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Isotope-only localisation for sentinel lymph node biopsy - medium-term oncological outcomes. Clin Breast Cancer 2022; 22:e636-e640. [DOI: 10.1016/j.clbc.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
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Magnoni F, Corso G, Gilardi L, Pagan E, Massari G, Girardi A, Ghidinelli F, Bagnardi V, Galimberti V, Grana CM, Veronesi P. Does failed mapping predict sentinel lymph node metastasis in cN0 breast cancer? Future Oncol 2021; 18:193-204. [PMID: 34882010 DOI: 10.2217/fon-2021-0470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.
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Affiliation(s)
- Francesca Magnoni
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Giovanni Corso
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy.,Departmentof Oncology & Hemato-Oncology, University of Milan, Milan, 20122, Italy
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milano, 20141, Italy
| | - Eleonora Pagan
- Department of Statistics & Quantitative Methods, University of Milan-Bicocca, Milan, 20126, Italy
| | - Giulia Massari
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Antonia Girardi
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | | | - Vincenzo Bagnardi
- Department of Statistics & Quantitative Methods, University of Milan-Bicocca, Milan, 20126, Italy
| | - Viviana Galimberti
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milano, 20141, Italy
| | - Paolo Veronesi
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy.,Departmentof Oncology & Hemato-Oncology, University of Milan, Milan, 20122, Italy
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Tsai LW, Lee YH, Lo C, Lien HC, Wang MY, Jan IS, Yen RF, Hu FC, Huang CS. Factors predicting one or two sentinel lymph nodes to be accepted for sentinel lymph node biopsy alone after neoadjuvant therapy in initially node-positive breast cancer patients. Surg Oncol 2021; 39:101667. [PMID: 34673474 DOI: 10.1016/j.suronc.2021.101667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current guidelines recommend harvesting ≥3 sentinel nodes if sentinel lymph node biopsy (SLNB) alone is considered after neoadjuvant therapy (NAT) for initially node-positive (cN+) breast cancer. We attempted to investigate factors predicting one or two sentinel lymph nodes harvested to be accepted for SLNB alone after NAT in initially cN + patients. METHODS Overall, 157 patients who received NAT (clinically T1-3/N1-2/M0) and underwent SLNB were identified from a prospectively maintained database. Significant factors were identified using a multiple logistic regression model. RESULTS The overall SLN identification rate was 83.4%. Failed SLN identification was associated with a 2-day protocol using a single tracer (odds ratio: 0.331 [95% confidence interval {CI}: 0.132-0.830], p = 0.018), age >52 years (0.345 [0.131-0.913], p = 0.032), and lobular histology (0.156 [0.026-0.944], p = 0.043). The overall false-negative SLNB rate was 14.7%. Its increased risk was associated with radioactivity count >530 for any SLN during SLNB (96.4 [4.00-2320], p = 0.005), age ≥57 years (34.2 [1.92-610], p = 0.016), and taxane use (105 [1.02-10700], p = 0.049); its decreased risk was associated with more harvested SLNs (0.191 [0.054-0.669], p = 0.01) and dual tracers (0.101 [0.012-0.843], p = 0.034). A predictive model using these factors achieved an area under the curve of 0.935 (95% CI: 0.878-0.991). CONCLUSION When taxane was administered during NAT, the false-negative rate was predicted at <5% for patients aged <57 years, if 1-2 SLNs were harvested using dual tracers, and when the count of every SLN was lower than 530 after NAT in cN + breast cancer.
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Affiliation(s)
- Li-Wei Tsai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiao Lo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Fu-Chang Hu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Predictive risk factors for sentinel lymph node nonvisualization on planar lymphoscintigraphy using an intratumoral injection in patients with primary breast cancer. Nucl Med Commun 2019; 40:317-324. [PMID: 30601244 DOI: 10.1097/mnm.0000000000000971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lymphoscintigraphy is considered a useful tool to optimize sentinel lymph node (SLN) identification. Nonvisualization of the SLN is associated with a lower SLN identification rate. The aim of this study was to identify preoperative factors associated with SLN nonvisualization on lymphoscintigraphy. PATIENTS AND METHODS A total of 2050 consecutive SLN procedures were evaluated from clinically node-negative breast cancer patients. Planar lymphoscintigraphy was performed at 3 h after an intratumoral injection of technetium-99m-nanocolloid. This technique was used for extra-axillary SLN identification. Patient, tumor, and treatment characteristics were analyzed for association with SLN nonvisualization. Factors with a P-value less than 0.1 in univariate analysis were included in a multivariate logistic regression model. RESULTS The SLN visualization rate was 86.7%. In multivariate logistic regression, age of at least 70 years [odds ratio (OR): 3.24; 95% confidence interval (CI): 2.14-4.91)], BMI of at least 30 (OR: 1.93; 95% CI: 1.39-2.69), T3/T4-tumors (OR: 2.70; 95% CI: 1.37-5.32), medially/centrally located tumors (OR: 1.52; 95% CI: 1.17-1.99), previous mantle field radiation (OR: 4.04; 95% CI: 1.74-9.35), nonpalpable tumors (OR: 1.88; 95% CI: 1.36-2.60), and presence of iodine seeds (OR: 1.35; 95% CI: 1.02-1.78) were associated significantly with nonvisualization on lymphoscintigraphy. Nonvisualization was the strongest independent predictor of unsuccessful intraoperative SLN identification (P<0.001). Overall, the SLN identification rate was 97.7% because of the use of additional imaging and blue dye. CONCLUSION This study reports new tumor and treatment-related risk factors for nonvisualization on lymphoscintigraphy by using an intratumoral injection in primary breast cancer. We recommend a periareolar subcutaneous injection to improve SLN visualization in patients with limited prognostic and therapeutic relevance of internal mammary chain SLN identification.
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Sahbai S, Taran FA, Staebler A, Wallwiener D, la Fougère C, Brucker S, Dittmann H. Sentinel lymph node mapping using SPECT/CT and gamma probe in endometrial cancer: an analysis of parameters affecting detection rate. Eur J Nucl Med Mol Imaging 2017; 44:1511-1519. [PMID: 28374119 DOI: 10.1007/s00259-017-3692-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE SPECT/CT after pericervical injection of technetium-99 m-nanocolloid was shown to be suitable for sentinel lymph node (SLN) mapping in endometrial cancer (EC). The aim of this study was to analyze factors affecting successful SLN detection by means of SPECT/CT such as imaging findings, patient characteristics and tumor biology in a large cohort of patients. METHODS One hundred and forty-five consecutive patients suffering from EC who received pre-surgical SLN mapping at our institution between 2011 and 2016 were included in this analysis. SPECT/CT data of abdomen and pelvis (mean 4:20 ± 1:20 h p.i.) were acquired after pericervical injection of technetium-99 m-nanocolloid (mean 230 ± 45 MBq) in all patients. Surgical staging was performed on the day after. Acquisition parameters, patient characteristics, SPECT/CT findings as well as histopathological results were collected. RESULTS A total of 282 SLNs were identified by means of SPECT/CT. Overall, preoperative and intraoperative SLN detection rates were 86%, 76% and 74% respectively. The most important factor associated with failure to detect SLNs was the presence of high bone marrow on SPECT/CT (p = 0.005). Peritoneal/abdominal radioactivity was also associated with missed SLN detection in SPECT/CT (p = 0.02). However, the presence of liver/spleen uptake on its own was not predictive for detection failure. Low numbers of detected SLNs in SPECT/CT were slightly related with older age and lower injected activity. No significant influence was found for the parameters of tumor histology and stage, lymph node involvement and the time gap between injection and imaging. CONCLUSIONS Venous drainage as indicated by bone marrow uptake is the most important factor associated with scintigraphic SLN detection failure. Moreover, high peritoneal and abdominal activity was also associated with detection failure. Thus, meticulous application of the radiotracer is crucial in EC.
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Affiliation(s)
- Samine Sahbai
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany.
| | - Florin-Andrei Taran
- Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Diethelm Wallwiener
- Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian la Fougère
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany
| | - Sara Brucker
- Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Helmut Dittmann
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Straße 14, 72076, Tübingen, Germany
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Ghosh D, Michalopoulos NV, Davidson T, Wickham F, Williams NR, Keshtgar MR. Sentinel node detection in early breast cancer with intraoperative portable gamma camera: UK experience. Breast 2016; 32:53-59. [PMID: 28033510 DOI: 10.1016/j.breast.2016.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/23/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Access to nuclear medicine department for sentinel node imaging remains an issue in number of hospitals in the UK and many parts of the world. Sentinella® is a portable imaging camera used intra-operatively to produce real time visual localisation of sentinel lymph nodes. METHODS Sentinella® was tested in a controlled laboratory environment at our centre and we report our experience on the first use of this technology from UK. Moreover, preoperative scintigrams of the axilla were obtained in 144 patients undergoing sentinel node biopsy using conventional gamma camera. Sentinella® scans were done intra-operatively to correlate with the pre-operative scintigram and to determine presence of any residual hot node after the axilla was deemed to be clear based on the silence of the hand held gamma probe. RESULTS Sentinella® detected significantly more nodes compared with CGC (p < 0.0001). Sentinella® picked up extra nodes in 5/144 cases after the axilla was found silent using hand held gamma probe. In 2/144 cases, extra nodes detected by Sentinella® confirmed presence of tumour cells that led to a complete axillary clearance. CONCLUSIONS Sentinella® is a reliable technique for intra-operative localisation of radioactive nodes. It provides increased nodal visualisation rates compared to static scintigram imaging and proves to be an important tool for harvesting all hot sentinel nodes. This portable gamma camera can definitely replace the use of conventional lymphoscintigrams saving time and money both for patients and the health system.
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Affiliation(s)
- Debashis Ghosh
- Department of Surgery, University College London, Royal Free London NHS Foundation Trust, UK
| | | | - Timothy Davidson
- Department of Surgery, University College London, Royal Free London NHS Foundation Trust, UK
| | - Fred Wickham
- Nuclear Medicine Department, Royal Free London NHS Foundation Trust, UK
| | - Norman R Williams
- Clinical Trials Group, UCL Division of Surgery and Interventional Science, Centre for Clinical Science and Technology, UK
| | - Mohammed R Keshtgar
- Department of Surgery, University College London, Royal Free London NHS Foundation Trust, UK
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Sahdev V, Albersen M, Christodoulidou M, Parnham A, Malone P, Nigam R, Bomanji J, Muneer A. Management of non-visualization following dynamic sentinel lymph node biopsy for squamous cell carcinoma of the penis. BJU Int 2016; 119:573-578. [DOI: 10.1111/bju.13680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Varun Sahdev
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Maarten Albersen
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
- University Hospitals Leuven; Leuven Belgium
| | | | - Arie Parnham
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Peter Malone
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Raj Nigam
- Department of Urology; University College London Hospitals NHS Foundation Trust; London UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine; University College London Hospital; London UK
| | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre; University College London Hospitals NHS Foundation Trust; London UK
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Thangarajah F, Malter W, Hamacher S, Schmidt M, Krämer S, Mallmann P, Kirn V. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67. Breast 2016; 30:87-91. [DOI: 10.1016/j.breast.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/29/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
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Sharma N, Pinto A, Notghi A, Sintler M. Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time? Indian J Surg 2015; 77:1480-3. [PMID: 27011606 PMCID: PMC4775584 DOI: 10.1007/s12262-013-0994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 10/10/2013] [Indexed: 10/26/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) remains the gold standard for assessing axillary node status in breast cancer. Preoperative scintigrams have been used to identify the sentinel lymph node (SLN); however, their use is controversial. Studies suggest they add little to successful SLN detection in theatre, immediately prior to node excision. They have been associated with high false negatives, time expense, patient dissatisfaction, and unnecessary costs. The aim of the present study was to evaluate the diagnostic accuracy of scintigrams in comparison to intraoperative SLN identification techniques. This study included all patients undergoing a SLNB for breast cancer from April 2010 to 2011. Scintigram reports, operation notes, and histology results were analyzed. Mann-Whitney U and chi-squared tests were used for statistical analysis of data. Two hundred nineteen female patients with a median age of 59.6 years (24.0-89.9 years) were included in this study. Scintigram was performed in 185 and not in 34 patients due to time constraints. Combined γ-probe and Isosulfan blue dye for SLN detection (intraoperative methods) have an identification rate of 98.2 % (p = 0.005), compared to 92.4 % (p = 0.088) from scintigrams alone. Scintigrams confer no additional advantage to the operating surgeon for successful SLN detection and excision in theatre. Intraoperative SLN identification is more accurate and reliable. Routine scintigram use is unjustified and should be withdrawn from current practice.
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Affiliation(s)
- N. Sharma
- />Royal Shrewsbury Hospital, Shrewsbury, UK
| | - A. Pinto
- />Royal Wolverhampton Hospital Trusts, Wolverhampton, UK
| | - A. Notghi
- />Sandwell and West Birmingham Hospital Trusts, Birmingham, UK
| | - M. Sintler
- />Sandwell and West Birmingham Hospital Trusts, Birmingham, UK
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Breast cancer lymphoscintigraphy: Factors associated with sentinel lymph node non visualization. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vaz SC, Silva Â, Sousa R, Ferreira TC, Esteves S, Carvalho IP, Ratão P, Daniel A, Salgado L. Breast cancer lymphoscintigraphy: Factors associated with sentinel lymph node non visualization. Rev Esp Med Nucl Imagen Mol 2015; 34:345-9. [PMID: 25986344 DOI: 10.1016/j.remn.2015.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/21/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate factors associated with non identification of the sentinel lymph node (SLN) in lymphoscintigraphy of breast cancer patients and analyze the relationship with SLN metastases. MATERIAL AND METHODS A single-center, cross-sectional and retrospective study was performed. Forty patients with lymphoscintigraphy without sentinel lymph node identification (negative lymphoscintigraphy - NL) were enrolled. The control group included 184 patients with SLN identification (positive lymphoscintigraphy - PL). Evaluated factors were age, body mass index (BMI), tumor size, histology, localization, preoperative breast lesion hookwire (harpoon) marking and SLN metastases. The statistical analysis was performed with uni- and multivariate logistic regression models and matched-pairs analysis. RESULTS Age (p=0.036) or having BMI (p=0.047) were the only factors significantly associated with NL. Being ≥60 years with a BMI ≥30 increased the odds of having a NL 2 and 3.8 times, respectively. Marking with hookwire seems to increase the likelihood of NL, but demonstrated statistical significance is lacking (p=0.087). The other tested variables did not affect the examination result. When controlling for age, BMI and marking with the harpoon, a significant association between lymph node metastization and NL was not found (p=0.565). CONCLUSIONS The most important factors related with non identification of SLN in the patients were age, BMI and marking with hook wire. However, only the first two had statistical importance. When these variables were controlled, no association was found between NL and axillary metastases.
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Affiliation(s)
- S C Vaz
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal.
| | - Â Silva
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - R Sousa
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - T C Ferreira
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - S Esteves
- Clinical Research Unit of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - I P Carvalho
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - P Ratão
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - A Daniel
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
| | - L Salgado
- Department of Nuclear Medicine of Portuguese Institute of Oncology, Lisbon Center, Portugal
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Tumor-infiltrating lymphocyte response in cutaneous melanoma in the elderly predicts clinical outcomes. Melanoma Res 2014; 23:132-7. [PMID: 23344159 DOI: 10.1097/cmr.0b013e32835e5880] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tumor-infiltrating lymphocytes (TILs) and regression are manifestations of the host immune response to tumor, but their influence on outcome remains undefined. There is a paucity of data on the elderly who represent a growing proportion of melanoma patients. The aim of this study was to evaluate the influence of TILs and regression as an indirect measure of immunity on outcome in elderly patients with melanoma. From a prospective database, we identified 250 consecutive cutaneous melanoma patients aged at least 65 years at the time of diagnosis. Data were verified by record review. Within the primary melanoma, a brisk TIL response was present in 66 (31%), nonbrisk TILs in 36 (17%), and absent in 111 (52%). The presence of a brisk infiltrate conferred a three-fold increased risk of sentinel lymph node (SLN) metastasis (P=0.02). Despite this, nonbrisk or absent TILs were associated with a five-fold increased risk of recurrence (P=0.0001). In multivariate analysis, nonbrisk or absent TILs were independently associated with recurrence (P<0.0001), diminished 5-year disease-free survival (76 vs. 91%, P=0.0006), and 5-year melanoma-specific survival (82 vs. 95%, P=0.0008). Regression was not an independent predictor of SLN metastasis, disease-free survival, or melanoma-specific survival. Our study demonstrates that an active antitumor immune response exists in elderly melanoma patients that, paradoxically, predicts both SLN metastasis and improved melanoma-specific outcomes. Further investigation to characterize this lymphocytic infiltrate and to confirm its clinical significance as a predictor of nodal status, patient outcome, and response to immunotherapy in elderly melanoma patients appears warranted.
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Prevalence and risk factors of intraoperative identification failure of sentinel lymph nodes in patients affected by breast cancer. Nucl Med Commun 2014; 34:664-73. [PMID: 23660760 DOI: 10.1097/mnm.0b013e328361cd84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) has progressively replaced complete axillary lymph node dissection in the evaluation of breast cancer patients with clinically node-negative disease. Our study investigates the rate of and risk factors involved in sentinel node identification failure. MATERIALS AND METHODS We collected data on SLNBs performed during 2002-2010, focusing on tumor, patient, and breast characteristics, radioactivity parameters, and operators' experience. Data were analyzed by R (v2.14.2), considering significance at P values lower than 0.05. RESULTS Among 1050 women who underwent an SLNB, the rate of identification failure was 2% (23/1050), which, on bivariate analysis, was seen to be significantly influenced (P<0.05) by the preoperative and intraoperative low radiotracer uptake (axilla/lesion radiotracer uptake ratio<1%), low level of experience of the specialist in nuclear medicine, luminal A subtype, and radiotracer uptake localization in internal mammary lymph nodes. On multivariate analysis, significant risk factors for sentinel node identification failure were found to be: axilla/lesion radiotracer uptake ratio less than 1%, radiotracer uptake localization in internal mammary lymph nodes, and luminal A subtype. Considering only the preoperative variables in our multivariate analysis, axilla/lesion radiotracer uptake ratio less than 1%, negative lymph node scintiscan, and radiotracer uptake localization in internal mammary lymph nodes had an area under the curve (receiver operating characteristic curve) of 96% (95% confidence interval 92-100%). Further, we built a nomogram based on these simple parameters for counseling the patient about the probability of not finding the sentinel lymph node during the surgical procedure. CONCLUSION The relatively low prevalence of SLNB failure (2%) is indicative of the accuracy of the procedure when performed by experienced surgeons. The sentinel node identification failure in our population seemed to be related to biological tumor factors (luminal A subtype) and probably to physiological or pathological variations in the lymphatic drainage (axilla/lesion radiotracer uptake ratio<1% and radiotracer uptake localization in internal mammary lymph nodes).
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Kohl Schwartz A, Leo C, Rufibach K, Varga Z, Fink D, Gabriel N. Does increased tumor burden of sentinel nodes in breast cancer affect detection procedure? Eur J Surg Oncol 2013; 39:266-72. [DOI: 10.1016/j.ejso.2012.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/03/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
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The accuracy of sentinel node biopsy in breast cancer patients with the history of previous surgical biopsy of the primary lesion: Systematic review and meta-analysis of the literature. Eur J Surg Oncol 2012; 38:95-109. [DOI: 10.1016/j.ejso.2011.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/25/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022] Open
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Correlation of number and identification of sentinel nodes during radiographer led lymphoscintigraphy prior to sentinel lymph node biopsy in breast cancer patients. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2011.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dordea M, Colvin H, Cox P, Pujol Nicolas A, Kanakala V, Iwuchukwu O. Clinical and histopathological factors affecting failed sentinel node localization in axillary staging for breast cancer. Surgeon 2012; 11:63-6. [PMID: 22281369 DOI: 10.1016/j.surge.2011.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/25/2011] [Accepted: 10/31/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has become the standard of care in axillary staging of clinically node-negative breast cancer patients. AIMS To analyze reasons for failure of SLN localization by means of a multivariate analysis of clinical and histopathological factors. METHODS We performed a review of 164 consecutive breast cancer patients who underwent SLNB. A superficial injection technique was used. RESULTS 9/164 patients failed to show nodes. In 7/9 patients no evidence of radioactivity or blue dye was observed. Age and nodal status were the only statistically significant factors (p < 0.05). For every unit increase in age there was a 9% reduced chance of failed SLN localization. Patients with negative nodal status have 90% reduced risk of failed sentinel node localization than patients with macro or extra capsular nodal invasion. DISCUSSION The results suggest that altered lymphatic dynamics secondary to tumour burden may play a role in failed sentinel node localization. We showed that in all failed localizations the radiocolloid persisted around the injection site, showing limited local diffusion only. While clinical and histopathological data may provide some clues as to why sentinel node localization fails, we further hypothesize that integrity of peri-areolar lymphatics is important for successful localization.
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Affiliation(s)
- Matei Dordea
- Breast Unit, Department of General Surgery, Sunderland Royal Hospital, Kayll Road, SR4 7TP Sunderland, United Kingdom.
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Koskivuo I, Hernberg M, Vihinen P, Virolainen S, Talve L, Seppänen M, Vahlberg T, Jahkola T. Sentinel lymph node biopsy and survival in elderly patients with cutaneous melanoma. Br J Surg 2011; 98:1400-7. [PMID: 21638276 DOI: 10.1002/bjs.7565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SNB) is a widely adopted staging procedure in patients with cutaneous melanoma. The benefits of SNB have not been evaluated thoroughly in older age groups. METHODS This was a two-centre retrospective observational study of patients with melanoma aged at least 70 years undergoing SNB. RESULTS A total of 423 patients were included. SNB was successful in 405 patients (95·7 per cent), of whom 88 (21·7 per cent) had sentinel node metastasis. During a median follow-up of 2·5 years, recurrence developed in 80 patients (18·9 per cent). Nodal recurrence developed in eight sentinel node-negative patients, giving a false-negative rate of 8·3 per cent, a sensitivity of 91·7 per cent and an overall diagnostic accuracy of 98·0 per cent. A total of 46 patients (10·9 per cent) died from melanoma and 42 (9·9 per cent) from other causes. At 5 years, the relapse-free survival rate was 80·0 per cent in sentinel node-negative patients and 39 per cent in node-positive patients; cancer-specific survival rates were 88·6 per cent and 46 per cent respectively (P < 0·001). In multivariable analysis, sentinel node metastasis (P < 0·001), a Breslow thickness of at least 2·0 mm (P = 0·007) and presence of ulceration (P = 0·012) were independent prognostic factors for cancer-specific survival. CONCLUSION SNB is a feasible and accurate technique for detecting nodal metastases in older patients with melanoma. Sentinel node status is the most important predictor of cancer-specific outcome in the elderly.
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Affiliation(s)
- I Koskivuo
- Department of Surgery, Turku University Hospital, Turku, Finland.
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Lymphatic Drainage Patterns of the Human Eyelid: Assessed by Lymphoscintigraphy. Ophthalmic Plast Reconstr Surg 2010; 26:281-5. [DOI: 10.1097/iop.0b013e3181c32e57] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer. ACTA ACUST UNITED AC 2010; 29:73-7. [DOI: 10.1016/j.remn.2009.10.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 10/26/2009] [Indexed: 11/21/2022]
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Conway WC, Faries MB, Nicholl MB, Terando AM, Glass EC, Sim M, Morton DL. Age-related lymphatic dysfunction in melanoma patients. Ann Surg Oncol 2009; 16:1548-52. [PMID: 19277787 DOI: 10.1245/s10434-009-0420-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 01/19/2009] [Accepted: 02/11/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Age-related outcomes have become increasingly common in evaluating patients with melanoma. For instance, as age increases, sentinel node (SN) nonidentification increases and SN positivity decreases. Furthermore, advanced age is a risk factor for in-transit disease. We hypothesized that increasing age is accompanied by alterations in lymphatic function, possibly explaining these findings. METHODS Our center's melanoma database was queried to identify patients who underwent successful sentinel node biopsy after lymphoscintigraphy. Records of those treated between 2000 and 2005 were reviewed for age, sex, drainage basin, intraoperative radioactivity, and SN pathology. RESULTS The 858 patients had a mean age of 55 years; 59% were men. Mean radioactivity in the hottest SN was 5232 counts per second; 179 patients (21%) had SN metastases. SN count rates were significantly and inversely related to age (P < .001 by Pearson correlation, analysis of variance, and chi(2) test). Mean counts per second were 6105, 5883, and 2720 for axillary, inguinal, and cervical basins, respectively (P < .01), and count rates in these basins were consistently lower with increasing age (neck and axilla, P < .001; groin, P = .060; Pearson correlation). Multivariate analysis confirmed an independent inverse association between age and count rates (P < .001), overall and within each primary tumor site. CONCLUSIONS Lymphatic function, as assessed by radiocolloid transit to and uptake within the SN, declines with age. Altered lymphatic function in older patients may modify metastatic patterns; knowledge of this may help clarify findings of reduced nodal positivity and increased in-transit disease in this population.
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Affiliation(s)
- W Charles Conway
- Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA
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Jayasinghe UW, Boyages J. Tumour location is not an independent prognostic factor for survival following a diagnosis of breast cancer. Breast 2009; 18:41-6. [DOI: 10.1016/j.breast.2008.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 10/07/2008] [Indexed: 11/16/2022] Open
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Sentinel lymph node detection and evidence of axillary lymphatic integrity after transaxillary breast augmentation: a prospective study using lymphoscintography. Aesthetic Plast Surg 2008; 32:879-88. [PMID: 18661171 DOI: 10.1007/s00266-008-9212-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG). METHODS Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p \ 0.05 significant, or p \ 0.017 when Bonferroni correction was applied. RESULTS All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG. CONCLUSION The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.
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Sado HN, Graf RM, Timi JRR, Urban CA, Yamada AS, Woellner LC, Ferreira EDC, Matias JEF. Linfonodo sentinela após mamoplastia de aumento pela via transaxilar: estudo prospectivo controlado por meio de linfocintilografia em 43 pacientes. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000500004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar se a mamoplastia de aumento pela via transaxilar apresenta potencial de prejudicar a identificação futura do linfonodo sentinela. MATERIAIS E MÉTODOS: Estudo prospectivo controlado em que foram selecionadas 22 pacientes divididas em grupo pós-mamoplastia e grupo controle, totalizando 43 mamas (22 no grupo pós-mamoplastia e 21 no grupo controle) avaliadas por meio de linfocintilografia imediatamente após injeções periareolares de fitato-99mTc. Os testes estatísticos consideraram como diferenças significativas valores de p < 0,05. RESULTADOS: Todas as mamas do grupo pós-mamoplastia apresentaram drenagem linfática para a cadeia axilar, sem diferença com o grupo controle (p = 0,488). A média de linfonodos captantes foi de 1,27 ± 0,46 no grupo pós-mamoplastia e 1,33 ± 0,58 no grupo controle (p = 0,895). A média de tempo para visualização do primeiro linfonodo foi de 3,14 ± 4,42 minutos no grupo pós-mamoplastia e 5,48 ± 5,06 minutos no grupo controle, novamente sem diferença significativa (p = 0,136). CONCLUSÃO: A mamoplastia de aumento pela via transaxilar não acarretou prejuízo na identificação futura do linfonodo sentinela.
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van der Ploeg IMC, Tanis PJ, Valdés Olmos RA, Kroon BBR, Rutgers EJT, Nieweg OE. Breast Cancer Patients with Extra-Axillary Sentinel Nodes Only may be Spared Axillary Lymph Node Dissection. Ann Surg Oncol 2008; 15:3239-43. [DOI: 10.1245/s10434-008-0120-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 07/21/2008] [Accepted: 07/22/2008] [Indexed: 11/18/2022]
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Clinical Significance of Preoperative Lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer. J Surg Res 2008; 148:191-6. [DOI: 10.1016/j.jss.2007.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 10/23/2007] [Accepted: 10/25/2007] [Indexed: 02/06/2023]
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Multiparametric analysis of preoperative lymphatic mapping with the use of combined deep plus superficial radiotracer injection technique in early breast cancer. Nucl Med Commun 2008; 29:546-52. [DOI: 10.1097/mnm.0b013e3282f63965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Veronesi U, Arnone P, Veronesi P, Galimberti V, Luini A, Rotmensz N, Botteri E, Ivaldi GB, Leonardi MC, Viale G, Sagona A, Paganelli G, Panzeri R, Orecchia R. The value of radiotherapy on metastatic internal mammary nodes in breast cancer. Results on a large series. Ann Oncol 2008; 19:1553-60. [PMID: 18467318 DOI: 10.1093/annonc/mdn183] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The 'regional nodal mapping', is a fundamental step to stage breast carcinoma. In addition to the axillary nodes status, the involvement of internal mammary nodes is an important prognostic factor. Six hundred and sixty-three patients with breast carcinoma, mainly in the inner quadrants, underwent a biopsy of internal mammary nodes. Positive internal mammary nodes were found in 68 out of 663 cases (10.3%) representing 27.2% of all cases with regional node metastases (250). When histologically proven metastases were detected, radiotherapy was administered to the internal mammary nodes chain. In 254 cases, the surgeon's exploration was guided by a gamma probe. Out of these cases, 28 (11.0%) showed metastatic involvement. Out of the other 409 cases, not radioguided, 40 showed positive nodes (9.8%). Patients with internal mammary metastases treated with radiotherapy and appropriate systemic treatment showed an excellent survival (95% at 5 years), a result which is in opposition to the previous experience, which stated that invasion of internal mammary nodes is an ominous prognostic sign. We assume that this excellent result is due to radiotherapy to internal mammary nodes and we propose that exploration of internal mammary nodes should be part of the staging process of carcinomas of the medial part of the breast.
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Affiliation(s)
- U Veronesi
- European Institute of Oncology, Milan, Italy.
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Soran A, Falk J, Bonaventura M, Keenan D, Ahrendt G, Johnson R. Does Failure to Visualize a Sentinel Node on Preoperative Lymphoscintigraphy Predict a Greater Likelihood of Axillary Lymph Node Positivity? J Am Coll Surg 2007; 205:66-71. [PMID: 17617334 DOI: 10.1016/j.jamcollsurg.2007.01.064] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 01/24/2007] [Accepted: 01/29/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) mapping has become the standard of care for axillary staging in women with early-stage breast cancer. The purpose of the study was to investigate the hypothesis that nonvisualization of SLN on lymphoscintigraphy (LSG) predicts a subset of patients at risk of having a substantial burden of axillary tumor as evidenced by higher rate of lymph node involvement. STUDY DESIGN We retrospectively reviewed the records of 1,500 patients who underwent dual-tracer SLN mapping for breast cancer between 1999 and 2004. LSG were reported as negative or positive. RESULTS Ninety-one percent had axillary SLN(s) identified on LSG imaging. In 133 of 134 (99.3%) patients with a negative LSG, SLN(s) was identified intraoperatively either by blue dye or hand-held gamma detection. SLN was positive in 28.4% of LSG nonvisualized group and was positive in 29.1% of LSG visualized group (p>0.05). A significantly higher percentage of women older than 50 years of age had nonvisualization of SLN (p<0.0001). Body mass index (calculated as kg/m2) was >30 in 42.5% of LSG nonvisualized group and in 26.3% in LSG visualized group (p<0.0001). CONCLUSIONS Failure to demonstrate axillary uptake by LSG appears to be related to technical factors and patient-related factors, such as body mass index and older age, but does not adversely affect SLN identification. The equivalent rate of positive SLNs in patients with a positive or negative LSG supports the null hypothesis that "failure to visualize" on LSG does not identify a subset of patients at higher risk of being axillary lymph node positive.
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Affiliation(s)
- Atilla Soran
- Department of Surgery, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Doting MHE, Stiekema HMA, de Vries J, Lemstra C, Hoekstra HJ, Vrieling M, Rietman L, Jager PL. Immediate dynamic lymphoscintigraphy delivers no additional value to lymphoscintigraphy 3 hr after tracer injection in sentinel lymph node biopsy in breast cancer patients. J Surg Oncol 2007; 95:469-75. [PMID: 17192946 DOI: 10.1002/jso.20721] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Immediate dynamic imaging enables accurate definition of sentinel lymph nodes, whereas imaging 3 hr after tracer injection may lead to overestimation of the number of sentinel lymph nodes. A study was performed to define the value of lymphoscintigraphy immediately versus 3 hr after tracer injection in sentinel lymph node biopsy for breast cancer management. METHODS In 165 sentinel lymph node biopsy procedures preoperative immediate and 3 hr post-injection lymphoscintigraphy was performed after intraparenchymal tracer administration. RESULTS Lymph node visualization occurred in 63 immediate procedures (38%) versus in 163 procedures 3 hr post-injection (99%). In 17 procedures (10%) in which immediate lymphoscintigraphy had visualized sentinel lymph nodes, additional nodes had been seen on 3 hr post-injection lymphoscintigraphy. In eight of these procedures (5%) all nodes were detected in the same draining lymph node basin. Non-axillary sentinel lymph nodes were identified by preoperative lymphoscintigraphy in 28 procedures (17%) and improved staging in three patients (5%). CONCLUSION The only impact of immediate lymphoscintigraphy was the possible omission of removal of 1-2 sec-echelon nodes per patient in 5% of patients. We consider this yield too low to continue immediate lymphoscintigraphy in breast cancer patients.
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Affiliation(s)
- M H Edwina Doting
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Tanaka C, Fujii H, Ikeda T, Jinno H, Nakahara T, Suzuki T, Kitagawa Y, Kitajima M, Ando Y, Kubo A. Stereoscopic scintigraphic imaging of breast cancer sentinel lymph nodes. Breast Cancer 2007; 14:92-9. [PMID: 17245002 DOI: 10.2325/jbcs.14.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymphoscintigraphy is used preoperatively to identify sentinel lymph nodes (SLNs). Conventional planar scintigraphy cannot provide three-dimensional(3D) information for SLN biopsy. We applied stereoscopic imaging to preoperative lymphoscintigraphy to obtain 3D information and evaluated its usefulness. METHODS Forty-four clinical stage I breast cancer patients (1 male, 43 females; age, 59.4+/-11.4 years) were enrolled in this study. Three hours after the injection of Tc-99m, 10 degrees of oblique images and routine anterior and lateral images were acquired. Anterior and lateral stereoscopic images were obtained in all studies, except for 2 patients; only lateral views were done for those. Two experienced radiologists enumerated the visualized hot nodes. RESULTS Stereoscopic imaging delineated more hot axillary lymph nodes compared to routine planar imaging in 8 of 42 patients (19.0%) on anterior view, 5 of 44 patients (11.4%) on lateral view, and 11 of 44 patients (25.0%) on either the anterior or lateral view. Statistically significant differences were observed between stereoscopic and routine planar imaging method on the anterior (p=0.012) and the lateral views (p=0.043). The stereoscopic imaging provided 3D information and effectively separated closely located hot nodes that were viewed as one hot node on conventional planar images. Thirty-eight out of 42 cases (90%) with anterior stereoscopic images identified the same number or more axillary hot nodes compared with lateral stereoscopic images. CONCLUSION The stereoscopic imaging method could improve the preoperative identification of SLNs. This method is technically simple, and could be a powerful diagnostic tool for SLN imaging breast cancer.
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Affiliation(s)
- Chikako Tanaka
- Department of Radiology, Keio University School of Medicine, Japan
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Povoski SP, Olsen JO, Young DC, Clarke J, Burak WE, Walker MJ, Carson WE, Yee LD, Agnese DM, Pozderac RV, Hall NC, Farrar WB. Prospective Randomized Clinical Trial Comparing Intradermal, Intraparenchymal, and Subareolar Injection Routes for Sentinel Lymph Node Mapping and Biopsy in Breast Cancer. Ann Surg Oncol 2006; 13:1412-21. [PMID: 16957969 DOI: 10.1245/s10434-006-9022-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 05/23/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple injection routes, including intradermal (ID), intraparenchymal (IP), and subareolar (SA), are used for 99mTc-sulfur colloid administration for sentinel lymph node (SLN) mapping and biopsy in breast cancer. The aim of this study was to compare localization by ID, IP, and SA injection routes based on preoperative lymphoscintigraphy and intraoperative identification. METHODS Four hundred prospectively randomized breast cancers underwent SLN mapping and biopsy. RESULTS Preoperative lymphoscintigraphy demonstrated localization to the axilla in 126/133 (95%) ID, 82/132 (62%) IP, and 96/133 (72%) SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.081 IP vs. SA), with a mean duration of preoperative lymphoscintigraphy of 139 +/- 18 minutes. Mean time to first localization when localization was demonstrated on preoperative lymphoscintigraphy was 8 +/- 14 minutes for ID, 53 +/- 49 for IP, and 22 +/- 29 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.003 IP vs. SA). Intraoperative identification of a SLN at the time of SLN biopsy was successful in 133/133 (100%) ID, 121/134 (90%) IP, and 126/133 (95%) SA (P < 0.001 ID vs IP; P = 0.014 ID vs. SA; P = 0.168 IP vs. SA), with a mean time from injection of 99mTc-sulfur colloid to start of SLN biopsy of 288 +/- 71 minutes. Mean intraoperative time to harvest the first SLN was 9 +/- 4 minutes for ID, 13 +/- 6 for IP, and 12 +/- 6 for SA (P < 0.001 ID vs. IP and ID vs. SA; P = 0.410 IP vs. SA). CONCLUSIONS The ID injection route demonstrated a significantly greater frequency of localization, decreased time to first localization on preoperative lymphoscintigraphy, and decreased time to harvest the first SLN. This represents the first prospective randomized clinical trial to confirm superiority of the ID route for administration of 99mTc-sulfur colloid during SLN mapping and biopsy in breast cancer.
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Affiliation(s)
- Stephen P Povoski
- Section of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA.
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González-Soto MJ, Bajén MT, Pla MJ, Carrera D, Gil D, Benito E, Ricart Y, Roca M, Martín-Comín J. [Influence of tumor location in patients with breast cancer on the sentinel node detection]. ACTA ACUST UNITED AC 2006; 25:98-102. [PMID: 16759615 DOI: 10.1157/13086251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the influence of tumour quadrant localization on the sentinel node (SN) detection and the visualisation of internal mammary chain (IM) drainage by radioisotopic techniques. 316 patients with breast cancer were studied. Mean age 57 years (range 29-88). All patients received 37-74 MBq of 99mTc-albumin nanocolloid in 2 ml by peritumoral injection. The breast cancer was located in the upper outer quadrant in 189 patients, in the upper inner in 57, in the lower outer in 57, in the lower inner in 55 and in the subareolar area in 18 patients. At two hours p.i., anterior and lateral chest lymphographies were obtained. The SN location was marked on the patient skin with permanent ink. SN was identified intraoperatively by the gamma probe. Histopatological analysis included imprints, delayed hematoxilin-eosin, inmunohistochemistry CAM 19-2 and PCR. RESULTS The scintigraphy and surgical detection was in the upper outer quadrant of 90 % and 93 % respectively; in the lower outer quadrant of 91 % and 95 %, in the upper inner quadrant of 93 % and 95 %, in the lower inner quadrant 87 % and 95 % and in the subareolar area in 94 % and 83 %. The IM chain drainage was of 6 % in the UO, in the LO of 5 %, in the UI of 12 %, in the LI of 20 % and none in subareolar. CONCLUSIONS Our data suggest that sentinel node location (quadrant) is not a influential factor in the scintigraphy and surgical detection. Tumours localised in internal quadrant show a higher rate of IM chain drainage.
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Affiliation(s)
- M J González-Soto
- Servicio de Medicina Nuclear, Hospital Universitario de Tenerife, La Laguna, Tenerife.
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Goyal A, Newcombe RG, Chhabra A, Mansel RE. Factors affecting failed localisation and false-negative rates of sentinel node biopsy in breast cancer--results of the ALMANAC validation phase. Breast Cancer Res Treat 2006; 99:203-8. [PMID: 16541308 DOI: 10.1007/s10549-006-9192-1] [Citation(s) in RCA: 239] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 02/07/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the widespread application of sentinel lymph node biopsy (SLNB) for early stage breast cancer, there is a wide variation in reported test performance characteristics. A major aim of this prospective multicentre validation study was to quantify detection and false-negative rates of SLNB and evaluate factors influencing them. METHODS Eight-hundred and fourty-two patients with clinically node-negative breast cancer underwent SLNB according to a standardised protocol that used a combination of radiopharmaceutical 99mTc-albumin colloid and Patent Blue V dye. SLNB was followed by standard axillary treatment at the same operation in all patients. RESULTS Sentinel lymph nodes (SLNs) were identified in 803 (96.1%) of 836 evaluable cases. The median number of SLNs removed per patient was 2 (range 1-9). There were 19 false negatives, resulting in a sensitivity of 263/282 (93.3%) and accuracy 782/803 (97.6%). SLNs were successfully identified by blue dye in 698 (85.6%), by isotope in 698 (85.6%), and by the combination of blue dye and isotope in 782 (96.0%) of 815 patients. Among 276 node positive patients, one or more positive SLNs were identified by blue dye in 251 (90.9%), by isotope in 246 (89.1%) and by the combination of blue dye and gamma probe in 258 (93.5%). Obesity, tumor location other than upper outer quadrant and non-visualisation of SLNs on the pre-operative lymphoscintiscan were significantly associated with failed localisation (p<0.001, p=0.008, p<0.001, respectively). The false-negative rate in patients with grade 3 tumors was 9.6%, compared with 4.7% in those with grade 2 tumors (p=0.022). The false-negative rate in patients who had one SLN harvested was 10.1%, compared with 1.1% in those who had multiple SLNs (three or more) removed (p=0.010). CONCLUSION SLNB can accurately determine whether axillary metastases are present in patients with early stage breast cancer with clinically negative axillary nodes. Both success and accuracy of SLNB are optimised by the combined use of blue dye and isotope. SLNB success decreases with increasing body mass, tumor location other than the upper outer quadrant and non-visualisation of hot nodes on the pre-operative lymphoscintiscan. This study demonstrates reduction in the predictive value of a negative SLNB in grade 3 tumors.
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Affiliation(s)
- Amit Goyal
- Department of Surgery, Wales College of Medicine, Cardiff University, Cardiff, United Kingdom
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Marchal F, Rauch P, Morel O, Mayer JC, Olivier P, Leroux A, Verhaeghe JL, Guillemin F. Results of preoperative lymphoscintigraphy for breast cancer are predictive of identification of axillary sentinel lymph nodes. World J Surg 2006; 30:55-62. [PMID: 16369717 DOI: 10.1007/s00268-005-0145-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to identify the variables associated with successful peroperative sentinel lymph node (SLN) localization. We studied 201 patients with T1, T2, N0 invasive breast cancer who underwent a SLN procedure from 1999 to 2003. Of these 201 patients, 55 underwent peritumoral and 146 underwent periareolar radioisotope injection before the blue dye injection. All patients were operated on by breast conservative surgery and axillary dissection after SLN biopsy. Age, weight, menopausal status, previous biopsy, localization of the tumor, results of lymphoscintigraphy, site of radiotracer injection, tumor size, tumor grade, experience of surgeons, and the number of invaded axillary nodes were analyzed to determine whether they had any significant correlation with successful identification of SLN. Variables found to have a statistically significant influence on the SLN identification rate and on preoperative lymphoscintigraphy identification were introduced into a univariate and multivariate logistic regression model. In multivariate analysis, successful lymphoscintigraphy (P < 0.0001) and the absence of metastatic axillary nodes (P < 0.005) were associated with successful identification of SLNs. The peritumoral injection of radiotracer (P < 0.001), patient age > 60 years (P < 0.003), and localization of the tumor in the upper outer quadrant (P < 0.004) were associated with failure of lymphoscintigraphic visualization of SLN. The technique of SLN detection thus appears to be better for patients with low risk of invaded axillary lymph nodes.
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Affiliation(s)
- Frédéric Marchal
- Department of Surgery, Centre Alexis Vautrin, Regional Cancer Center, Av. de Bourgogne, Vandoeuvre-Lès-Nancy, 54511, France.
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Goyal A, Mansel RE. Does imaging in sentinel node scintigraphic localization add value to the procedure in patients with breast cancer? Nucl Med Commun 2006; 26:845-7. [PMID: 16160642 DOI: 10.1097/00006231-200510000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Imaging sentinel nodes with pre-operative lymphoscintigraphy effectively assures successful sentinel node identification. However, sentinel nodes are still identified in the majority of image negative patients. Given the logistics and cost required to perform pre-operative lymphoscintigraphy its routine use may not be justified. It may be valuable for surgeons in the learning phase and in obese patients who have increased risk of intra-operative failed localization. A negative pre-operative lymphoscintiscan predicts inability to localize with the hand-held gamma probe. Patients with no 'hot node' on the lymphoscintiscan are more likely to have failed localization using the gamma probe only. Therefore, blue dye should be used along with the gamma probe to optimize the localization rate in these patients.
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Wunderbaldinger P. Problems and prospects of modern lymph node imaging. Eur J Radiol 2006; 58:325-37. [PMID: 16464553 DOI: 10.1016/j.ejrad.2005.12.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 12/26/2005] [Accepted: 12/30/2005] [Indexed: 10/25/2022]
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Chen YW, Chuang YW, Lai YC, Hsieh JS, Liu GC, Hou MF. Is early dynamic lymphoscintigraphy for detection of sentinel lymph nodes always achievable in breast tumor? Ann Nucl Med 2006; 20:45-50. [PMID: 16485574 DOI: 10.1007/bf02985590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In this article, we will discuss the achievement of early dynamic lymphoscintigraphic protocol and compare detection of sentinel node between benign and malignant breast tumors, and whether pathologic factor is related or not. METHODS During a six-month period, consecutive fifty-nine patients were enrolled into our study. The average age of patients was 47.6 +/- 9.8 years and all of them were clinically suspected of having breast cancer. The average tumor was 2.1 +/- 1.1 cm in size. First, Tc-99m sulfur colloid was injected around corners of palpable mass or biopsy cavity by the hybrid injection method. Immediately thereafter, dynamic protocol of lymphoscintigraphy, with 10 sec per frame for 60 frames was performed by established simultaneous dual-head vertical angle imaging technique. And delayed two-hour image was also acquired. All patients underwent surgery sixteen to twenty hours later and had a final pathological diagnosis. RESULTS Among 59 patients, 14 of them were diagnosed with fibroadenoma and the other 45 cases with malignant conditions, infiltrating duct carcinoma mostly. The average age of the two groups was similar. From the summation image of dynamic study, identified axillary sentinel nodal activity was found as 80% in the group of benign breast tumor, but only 48% in the group of malignant breast tumor. In more than 88% of patients, sentinel lymph node was detectable on the delayed two-hour image between the two groups. CONCLUSIONS Early dynamic protocol of pre-operative lymphoscintigraphy is helpful to clarify the relationship between the local lymphatic drainage basin and sentinel nodal uptake. However, this short period of protocol is not always achievable to detect sentinel node, especially in the group with breast malignant lesions.
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Affiliation(s)
- Yu-Wen Chen
- Department of Nuclear Medicine, Chou-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan
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Chagpar AB, Kehdy F, Scoggins CR, Martin RCG, Carlson DJ, Laidley AL, El-Eid SE, McGlothin TQ, Noyes RD, Ley PB, Tuttle TM, McMasters KM. Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer. Am J Surg 2005; 190:557-62. [PMID: 16164919 DOI: 10.1016/j.amjsurg.2005.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 06/16/2005] [Accepted: 06/16/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy examination is an accepted method of staging breast cancer patients. SLN biopsy examination in patients with drainage to the internal mammary chain (IMC) nodes is controversial. METHODS A prospective study of SLN biopsy examination followed by axillary dissection was analyzed to determine how surgeons manage patients with IMC drainage and the rates of axillary SLN identification and positivity in these cases. RESULTS Lymphoscintigraphy was performed in 2196 (53.2%) of the 4131 patients in this study. IMC drainage was noted in 80 patients (3.6%). An axillary SLN was identified in 29 of the 40 patients with IMC drainage alone (72.5%). The rate of finding a positive axillary lymph node did not differ based on the lymphoscintigraphic pattern (P = .470). CONCLUSIONS Most surgeons do not perform IMC SLN biopsy procedures. Even when lymphoscintigraphy shows isolated drainage to IMC nodes, axillary SLNs usually are identified. Lymphoscintigraphy therefore has limited usefulness.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, University of Louisville, 315 E. Broadway, Suite 312, Louisville, KY 40202, USA.
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Chagpar AB, Martin RC, Scoggins CR, Carlson DJ, Laidley AL, El-Eid SE, McGlothin TQ, Noyes RD, Ley PB, Tuttle TM, McMasters KM. Factors predicting failure to identify a sentinel lymph node in breast cancer. Surgery 2005; 138:56-63. [PMID: 16003317 DOI: 10.1016/j.surg.2005.03.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although sentinel lymph node (SLN) biopsy is widely accepted as a minimally invasive method of nodal staging, failure to identify an SLN mandates a level I/II axillary node dissection. The purpose of this study was to elucidate factors that independently predict failure to identify an SLN. METHODS Using a large multicenter prospective study of SLN biopsy for patients with invasive breast cancer, we performed univariate and multivariate regression analyses to determine clinicopathologic factors predictive of failure to identify an SLN. RESULTS Of the total 4131 patients in the study, an SLN was not identified in 249 (6.0%). Tumor location (P = .409), biopsy type (P = .079), surgery type (P = .380), and histologic subtype (P = .999) were not significant predictors of failure to identify an SLN. On multivariate analysis, age greater than 60 years (OR = 1.469; 95% CI, 1.116-1.934, P = .006), nonpalpable tumors (OR = 0.639; 95% CI, 0.479-0.852, P = .002), injection technique with blue dye alone (OR = 0.389, 95% CI, 0.259-5.86, P < .001), and surgical experience of less than 10 SLN biopsy cases (OR = 1.886; 1.428-2.492, P < .001) were significant independent predictors of failure to identify an SLN. Optimal SLN biopsy technique using an intradermal and/or subareolar injection of radioactive colloid and blue dye can improve SLN identification rates regardless of patient and tumor characteristics. CONCLUSIONS Patient age and tumor palpability significantly affect the ability to identify an SLN in patients with breast cancer. Optimal injection technique can significantly improve sentinel node identification rate regardless of these factors.
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Affiliation(s)
- Anees B Chagpar
- Division of Surgical Oncology, Department of Surgery, University of Louisville, KY, USA.
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Harlow SP. Is preoperative lymphoscintigraphy needed for sentinel node procedures in breast cancer? Ann Surg Oncol 2005; 12:515-6. [PMID: 15947867 DOI: 10.1245/aso.2005.03.900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Accepted: 04/17/2005] [Indexed: 11/18/2022]
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Pandey M, Deo SVS, Maharajan R. Fallacies of preoperative lymphoscintigraphy in detecting sentinel node in breast cancer. World J Surg Oncol 2005; 3:31. [PMID: 15927059 PMCID: PMC1156960 DOI: 10.1186/1477-7819-3-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 05/31/2005] [Indexed: 01/15/2023] Open
Abstract
Background Preoperative lymphoscintigraphy is one of the three methods of evaluating sentinel nodes in patients with breast cancer; however, it has been reported to have a high false negative rate. Case presentations We report here two cases where the preoperative lymphoscintigraphy was found to be fallacious. A 44-year-old female with T2N0 breast cancer underwent preoperative lymphoscintigraphy with Tc99 sulfur colloid which failed to show any uptake in axilla or internal mammary chain. Intraoperative scintigraphy with blue dye and hand held gamma probe identified sentinel lymph node in axilla. Another patient with T2N0 lesion underwent preoperative lymphoscintigraphy which showed a sentinel lymph node in axilla and another in supraclevicular fossa. Intraoperative scintigraphy failed to show supraclevicular node however axillary node was correctly identified. Conclusion These two cases further strengthen the need to carry out triple test in identification of sentinel lymph node in patients with breast cancer. It also demonstrates the fallacies of preoperative lymphoscintigraphy.
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Affiliation(s)
- Manoj Pandey
- Surgical Oncology, Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India
| | - Surya VS Deo
- Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - R Maharajan
- Department of Nuclear Medicine, West fort Hi-tech Hospital Ltd, Punkunnam, Thrissure 680 002, India
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Kroon BK, Valdés Olmos R, Nieweg OE, Horenblas S. Non-visualization of sentinel lymph nodes in penile carcinoma. Eur J Nucl Med Mol Imaging 2005; 32:1096-9. [PMID: 15875177 DOI: 10.1007/s00259-005-1822-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 03/22/2005] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to analyse the incidence and cause of non-visualization of sentinel lymph nodes on preoperative lymphoscintigrams for penile cancer and its implications for further management. METHODS Preoperative lymphoscintigraphy was performed after injection of (99m)Tc-labelled nanocolloid in 123 clinically node-negative penile carcinoma patients. Anterior dynamic lymphoscintigraphy was performed during 20 min immediately after tracer injection. Subsequently, 5-min anterior and lateral static images were obtained 30 min and 2 h post injection. RESULTS Lymphatic drainage to both groins was seen in 98 patients (79%), unilateral drainage in 23 patients (19%) and no drainage at all in two patients (2%). Thus, in 27 (11%) of 246 groins, no sentinel node was visualized. The amount of administered tracer dose was associated with non-visualization (p=0.01). Unilateral drainage was initially interpreted as a normal physiological phenomenon. After the occurrence of a tumour-positive node in a non-visualized groin, we explore non-visualized groins by blue dye mapping and intraoperative palpation. Sentinel nodes were retrieved in four out of eight such groins, of which one contained metastasis. CONCLUSION In penile carcinoma patients, preoperative lymphoscintigraphy visualizes a sentinel node in 89% of groins. Visualization depends on the administered tracer dose. It is worthwhile to explore non-visualized groins. Sentinel nodes can be intraoperatively identified in more than half of these cases.
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Affiliation(s)
- Bin K Kroon
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Rousseau C, Classe JM, Campion L, Curtet C, Dravet F, Pioud R, Sagan C, Bridji B, Resche I. The Impact of Nonvisualization of Sentinel Nodes on Lymphoscintigraphy in Breast Cancer. Ann Surg Oncol 2005; 12:533-8. [PMID: 15889212 DOI: 10.1245/aso.2005.07.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 01/19/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed at evaluating the relationship between the nonvisualization of sentinel nodes (SNs) at lymphoscintigraphy and the intraoperative detection rate, radioactive counts in vivo, and histological status of SNs. METHODS Two hundred eighty patients with infiltrating breast carcinoma (T0, T(1)/T(2)) underwent preoperative lymphoscintigraphy before gamma probe-guided SN biopsy. RESULTS The surgical identification rate with a gamma probe was 84.6% (56 of 280) in lymphoscintigraphy-negative patients and 93.2% (224 of 280) in lymphoscintigraphy-positive patients (P < .05) after two subdermal periareolar injections. The average number of SNs per patient was 1.7 in lymphoscintigraphy-negative patients and 2.2 in lymphoscintigraphy-positive patients (P < .01), as assessed by gamma detection. The mean age of lymphoscintigraphy-negative patients was 62 +/- 10 years, versus 55 +/- 13 years for lymphoscintigraphy-positive patients (P < .001). The median radioactive count in dissected SNs identified by gamma detection was 204 cps (range, 4-618 cps) in lymphoscintigraphy-negative patients, versus 606 cps (range, 43-16,928 cps) in lymphoscintigraphy-positive patients (P < .001). The rate of macrometastatic SNs was 40% in lymphoscintigraphy-negative patients, versus 30% in lymphoscintigraphy-positive patients (not significant), whereas the size of involved SNs was 16.6 mm in lymphoscintigraphy-negative patients, versus 13.1 in lymphoscintigraphy-positive patients (P < .05). The micrometastasis detection rate in SNs from lymphoscintigraphy-negative patients was 6.25%, versus 23.3% in lymphoscintigraphy-positive patients (P < .01). CONCLUSIONS Negative lymphoscintigraphy was observed in 20% of patients and was more frequent in elderly patients. Negative lymphoscintigraphy was predictive of a lower surgical identification rate and fewer detected SNs. These SNs had fewer micrometastases, were fairly large, and tended to harbor metastases.
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Affiliation(s)
- C Rousseau
- Service of Nuclear Medicine, René Gauducheau Cancer Center Nantes-Saint Herblain, Boulevard Monod, 44805 Saint Herblain Cedex, France.
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Vijayakumar V, Boerner PS, Jani AB, Vijayakumar S. A critical review of variables affecting the accuracy and false-negative rate of sentinel node biopsy procedures in early breast cancer. Nucl Med Commun 2005; 26:395-405. [PMID: 15838421 DOI: 10.1097/00006231-200505000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radionuclide sentinel lymph node localization and biopsy is a staging procedure that is being increasingly used to evaluate patients with invasive breast cancer who have clinically normal axillary nodes. The most important prognostic indicator in patients with invasive breast cancer is the axillary node status, which must also be known for correct staging, and influences the selection of adjuvant therapies. The accuracy of sentinel lymph node localization depends on a number of factors, including the injection method, the operating surgeon's experience and the hospital setting. The efficacy of sentinel lymph node mapping can be determined by two measures: the sentinel lymph node identification rate and the false-negative rate. Of these, the false-negative rate is the most important, based on a review of 92 studies. As sentinel lymph node procedures vary widely, nuclear medicine physicians and radiologists must be acquainted with the advantages and disadvantages of the various techniques. In this review, the factors that influence the success of different techniques are examined, and studies which have investigated false-negative rates and/or sentinel lymph node identification rates are summarized.
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Affiliation(s)
- Vani Vijayakumar
- Nuclear Medicine Section, Department of Radiology, University of Texas Medical Branch, Galveston, Texas 77555-0793, USA.
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Pelosi E, Ala A, Bellò M, Douroukas A, Migliaretti G, Berardengo E, Varetto T, Bussone R, Bisi G. Impact of axillary nodal metastases on lymphatic mapping and sentinel lymph node identification rate in patients with early stage breast cancer. Eur J Nucl Med Mol Imaging 2005; 32:937-42. [PMID: 15838690 DOI: 10.1007/s00259-005-1797-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to define the impact of the presence of axillary nodal metastases on lymphatic mapping and sentinel lymph node (SLN) identification rate in patients with early breast cancer. METHODS Two hundred and forty-six lymphatic mapping procedures were performed with both labelled nanocolloid and blue dye, followed by SLN biopsy and/or complete axillary dissection. The following parameters were recorded: patient's age, tumour laterality and location, tumour size, tumour histology, tumour stage, tumour grade, lymphovascular invasion, radiotracer injection site (subdermal-peritumoural/peri-areolar), SLN visualisation at lymphoscintigraphy, SLN metastases (presence/absence, size) and other axillary metastases (presence/absence, number). Discriminant analysis was used to analyse the data. RESULTS SLNs were identified by labelled nanocolloid alone in 94.7% of tumours, by blue dye alone in 93.5% and by the combined technique in 99.2%. Discriminant analysis showed the gamma probe SLN identification rate to be significantly limited by the presence of axillary nodal metastases. In particular, the size of SLN metastases and the number of other axillary metastases were the most important variables in reducing the gamma probe SLN identification rate (p = 0.004 and p = 0.002, respectively). On the other hand, high tumour grade was the only parameter limiting the blue dye SLN identification rate. CONCLUSION The accuracy of lymphatic mapping with labelled nanocolloid is limited by the presence of axillary nodal metastases, and particularly by the degree of SLN tumoural invasion and the presence and number of other axillary nodal metastases. Neither of these elements seems to interfere with the blue dye identification rate. The combination of the two tracers maximises the SLN identification rate.
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Affiliation(s)
- Ettore Pelosi
- S.C.D.U. Medicina Nucleare 2, Ospedale S. Giovanni Battista, Turin, Italy
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Goyal A, Newcombe RG, Mansel RE. Clinical relevance of multiple sentinel nodes in patients with breast cancer. Br J Surg 2005; 92:438-42. [PMID: 15672428 DOI: 10.1002/bjs.4906] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Indiscriminate removal of axillary nodes may not be justified as it may potentially worsen the morbidity of the sentinel lymph node biopsy (SNB) procedure. This study examined the factors associated with removal of multiple sentinel lymph nodes and determined whether there was an upper threshold for the number of sentinel nodes that should be removed.
Methods
A total of 803 patients with breast cancer underwent successful SNB using peritumoral injection of 99mTc-labelled albumin colloid and Patent Blue V dye. SNB was followed by standard axillary treatment at the same operation in all patients.
Results
The mean number of sentinel nodes removed per procedure was 2·2 (range 1–9). Multiple sentinel nodes (mean 2·9, range 2–9) were found in 501 patients (62·4 per cent). The false-negative rate in patients who had one sentinel node harvested was 10 per cent, compared with 1 per cent in patients who had three or more nodes removed (P = 0·010). Factors associated with finding multiple sentinel nodes were age less than 50 years (P = 0·004), low body mass index (P < 0·001), tumour in the outer half of the breast (P = 0·013), sentinel node visualization on lymphoscintigraphy (P < 0·001) and an interval of 12 h or less between radioisotope injection and SNB (P = 0·014). For 99·6 per cent of node-positive tumours, metastasis was detected within the first four sentinel nodes removed.
Conclusion
The identification of multiple sentinel nodes, when present, reduced the false-negative rate. These data suggested that removal of more than four nodes was unnecessary.
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Affiliation(s)
- A Goyal
- Department of Surgery, Cardiff University, Cardiff CF14 4XN, UK
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Goyal A, Newcombe RG, Mansel RE, Chetty U, Ell P, Fallowfield L, Kissin M, Sibbering M. Role of routine preoperative lymphoscintigraphy in sentinel node biopsy for breast cancer. Eur J Cancer 2005; 41:238-43. [PMID: 15661548 DOI: 10.1016/j.ejca.2004.05.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Revised: 05/10/2004] [Accepted: 05/11/2004] [Indexed: 11/18/2022]
Abstract
Sentinel node biopsy (SNB) is rapidly emerging as the preferred technique for nodal staging in breast cancer. When radioactive colloid is used, a preoperative lymphoscintiscan is obtained to ease sentinel lymph node (SN) identification. This study evaluates whether preoperative lymphoscintigraphy adds diagnostic accuracy to offset the additional time and cost required. 823 breast cancer patients underwent SNB based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 99 mTc-nanocolloid and Patent Blue V injected peritumourally. The SNB was followed by standard axillary treatment at the same operation. Preoperative lymphoscintigraphy was performed around 3 h after the radioisotope injection. Preoperative lymphoscintigraphy revealed SNs in 593 (72%) of the 823 patients imaged. SN visualisation on lymphoscintigraphy was less successful in large tumours and tumours involving the upper outer quadrant of the breast (P=0.046, P<0.001, respectively). Lymphoscintigraphy showed internal mammary sentinel nodes in 9% (62/707) patients. The SN was identified intraoperatively in 98% (581) patients who had SN visualised on preoperative lymphoscintigraphy, with a false-negative rate of 7%. In patients who did not have SN visualised on preoperative lymphoscintigraphy, the SN was identified at operation in 90% (204) patients, with a false-negative rate of 7%. The SN identification rate was significantly higher in patients with SN visualised on preoperative lymphoscintigraphy (P<0.001). SN identification rate intraoperatively using the gamma probe was significantly higher in the SN visualised group compared with the SN non-visualised group (95% vs. 68%; chi square (1 degrees of freedom (df)) P<0.001. There was no statistically significant difference in the false-negative rate and the operative time between the two groups. A mean of 2.3 (standard deviation (SD) 1.3) SNs per patient were removed in patients with SN visualised on preoperative lymphoscintigraphy compared with 1.8 (SD 1.2) in patients with no SN visualised on lymphoscintigraphy (P<0.001). Although SN visualisation on preoperative lymphoscintigraphy significantly improved the intraoperative SN localisation rate, SN was successfully identified in 90% of patients with no SN visualisation on lymphoscintigraphy. Given the time and cost required to perform routine preoperative lymphoscintigraphy, these data suggest that it may not be necessary in all cases. It may be valuable for surgeons in the learning phase to shorten the learning curve and in patients who have increased risk of intraoperative failed localisation (obese or old patients). A negative preoperative lymphoscintiscan predicts the inability to localise with the hand-held gamma probe. Therefore, if the SN is not visualised on lymphoscintigraphy then the addition of intraoperative blue dye is recommended to increase the likelihood of SN identification.
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Affiliation(s)
- Amit Goyal
- Department of Surgery, University of Wales College of Medicine, Cardiff, CF14 4XN, UK
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